1. Oxygenation, not intubation, is the priority at all times including during tracheal extubation. |
2. Airway equipment should be purchased with the least experienced potential user in mind, and not the most experienced (i.e., ideally, devices should be intuitive and user-friendly, requiring a short training period). |
3. Devices should have sufficient evidence from reliable research to support their clinical role. |
4. Rescue devices should have a close to 100% success rate to ensure the minimal number of steps when securing the airway. A device with a high success rate in routine use may have a lower success rate when used as a rescue maneuver, especially when the difficult airway is unexpected. Urgency and operator’s anxiety of impending patient morbidity or mortality is likely to hinder the success of any device. |
5. Devices should be trialed over an adequate period of time (several weeks or months in most cases, and a sufficient number of times, preferably more than 50) to ensure that they are used for a variety of airway problems and by an adequate cross-section of staff. |
6. To be successful, extubation should be planned in a similar manner to intubation. To be more specific, extubation techniques should be tailored to the type of expected airway difficulties. Preparation for re-intubation should be part of the extubation management plan with a clear indication of when an intervention is or is not working and when to seek alternative methods. |
7. Technical and non-technical training in all clinical environments must follow the implementation of new airway management and oxygenation devices. |