Project for Universal Management of Airways

Airway management is practised by a wide variety of clinicians across a diverse range of settings, for numerous indications. Published airway guidelines have traditionally been developed by societies representing specific geographical regions, to address the requirements of airway operators practising in a particular discipline and context - typically focusing on the situation where intubation is the primary goal. Such guidelines are important to highlight the requirements for safe, effective care in these defined circumstances but may obscure the core underlying principles that transcend the context in which airway management occurs. In addition their context specific nature prevents them being directly applied to some clinical situations.

The goal of the  Project for Universal Management of Airways is to produce a set of principles that reflects, as much as possible, the consensus of existing published airway guidelines and can be applied to all episodes of airway care, across boundaries of geography, clinical discipline or context. The term 'universal' is used to reflect that the guideline developed will not only reflect international consensus but that it articulates appropriate management principles independent of: 

• Geography

• Provider: anesthesiologists, emergency physicians, intensivists, neonatologists, pre-hospital clinicians, nurse anesthetists, airway assistants, surgeons - whether trainees or consultants

• Patient characteristics: adult, paediatric, obstetric, trauma, critically-ill, fasted, unfasted

• Indication: surgery, resuscitation, respiratory compromise, impaired conscious state, etc

• Urgency: emergency, elective

• Location: operating room, emergency department, intensive care unit, ‘off-the-floor’ anesthetising locations, wards, prehospital

• Complexity: routine or complex cases, independent of whether airway difficulty is anticipated or encountered

• Primary intended airway: face-mask, supraglottic airway or tracheal tube.

The intention is for the universal guideline to complement existing guidelines by emphasising unifying basic principles, facilitating interdisciplinary team performance and assisting to standardise the approach to airway management globally.

The PUMA project will produce six main documents that together provide comprehensive recommendations for airway management.

1. Universal Guidelines for Providing a Foundation for Airway Management: What is required to make all episodes of airway management safe and effective?

2. Universal Guidelines for Evaluating the Risks of Airway Management: What should clinicians be looking for?

3. Universal Guidelines for Formulating an Airway Strategy: How should the airway be managed? What is the plan if that plan fails?

4. Universal Guidelines for Preparing for Airway Management: How can readiness to perform a given episode of airway management be optimised?

5. Universal Guidelines for Implementing Airway Management: Undertaking airway management interventions. What if it all goes wrong?

6. Universal Guidelines for Communicating Airway Outcomes and Optimising Future Care: What should the next person be told? How do we evaluate & improve our practice?

In addition to the above papers, PUMA will also work with the international airway societies* to develop a standalone Consensus guideline for preventing unrecognised oesophageal intubation. Like all PUMA publications, this guideline will have universal applicability across disciplines, geographical locations and contexts. For the purposes of developing this consensus guideline, affiliated members of the PUMA working group have been appointed to act as representatives for each of the international airway societies. The final guideline will be endorsed by all of the contributing airway societies.

*Difficult Airway Society, Society for Airway Management, European Airway Management Society, All India Difficult Airway Association, Canadian Airway Focus Group, Safe Airway Society, International Airway Management Society

In addition to providing comprehensive universal guidelines for airway management, PUMA will develop free educational resources to facilitate their translation into clinical practice. Lesson plans, videos, online quizzes and other learner and educator resources will be added to the website as they become available.

Nicholas Chrimes, Anaesthesia, Australia (Project Director)

Carin Hagberg, Anesthesiology, United States (Executive Chair)

Paul Baker, Anaesthesia, New Zealand

Richard Cooper, Anesthesiology, Canada 

Robert Greif, Anaesthesiology, Switzerland

Andy Higgs, Anaesthesia and Intensive Care Medicine, United Kingdom

George Kovacs, Emergency Medicine, Canada

J. Adam Law, Anesthesiology, Canada

Sheila Nainan Myatra, Anaesthesiology and Intensive Care Medicine, India

Ellen O'Sullivan, Anaesthesiology, Ireland

William Rosenblatt, Anesthesiology, United States

Christopher Ross, Emergency Medicine, United States

John Sakles, Emergency Medicine, United States

Massimiliano Sorbello, Anaesthesiology and Intensive Care Medicine, Italy

Special Contributor to Foundation Guideline

Stuart Marshall, Anaesthesia and Human Factors, Australia

Special Contributor to Strategy Guideline

Louise Ellard, Anaesthesia, Australia

Special Contributors to Preventing Unrecognised Oesophageal Intubation Guideline

Tim Cook, Anaesthesia and Intensive Care Medicine, United Kingdom

Stuart Marshall, Anaesthesia and Human Factors, Australia

• Pedro Acha, Emergency Medicine, Spain

• Imran Ahmad, Anaesthesia, United Kingdom

• Tak Asai, Anesthesiology, Japan

• Michael Aziz, Anesthesiology, United States

• Darren Braude, Emergency Medicine and Paramedicine, United States

• David Brewster, Intensive Care Medicine and Anaesthesia, Australia

• Martin Bromiley, Airline Pilot & Founder of Clinical Human Factors Group, United Kingdom

• Calvin Brown, Emergency Physician, United States

• Garry Brydges, Certified Registered Nurse Anesthetist, United States

• Simon Carley, Emergency Medicine, United Kingdom

• Pedro Charco Mora, Anesthesiology and Intensive Care, Spain

• Tim Cook, Anaesthesia and Intensive Care Medicine, United Kingdom

• Anil D'Cruz, ENT Surgery, India

• Pierre Diemunsch, Anaesthesiology and Intensive Care Medicine, France

• Karen Domino, Anesthesiology, United States

• Laura Duggan, Anesthesiology, Canada

• Yasmin Endlich, Anaesthesia, Australia

• Thomas Engelhardt, Anaesthesia, United Kingdom

• John Fiadjoe, Anesthesiology, United States

• Juan Carlos Flores-Carillo, Intensive Care Medicine, Mexico

• Kirstin Fraser, Anaesthetic Technician, New Zealand

• Paul Gardiner, Anaesthesia and Intensive Care Medicine, New Zealand

• John Gatward, Intensive Care Medicine and Anaesthesia, Australia

• Damien Gilby, Neonatology, Australia

• Keith Greenland, Anaesthesia, Australia

• Thomas Heidegger, Anaesthesiology, Switzerland

• Eric Hodgson, Anaesthesiology, South Africa

• Ross Hofmeyr, Anaesthesiology and Emergency Medicine, South Africa

• Russ Horowitz, Intensive Care and Emergency Medicine, United States

• Mike Hubble, Paramedic, United States

• Hans Huitink, Anaesthesiology, Netherlands

• Mike Huntington, Operating Department Practitioner, United Kingdom

• Samir Jaber, Intensive Care Medicine, France

• Narasimhan Jagannathan, Anesthesiology, United States

• Fiona Kelly, Anaesthetist and Human Factors Specialist, United Kingdom

• Sachin Kheterpal, Anesthesiology, United States

• Michael Kristensen, Anaesthesiology, Denmark

• Olivier Langeron, Anaesthesiology and Intensive Care Medicine, France

• Richard Levitan, Emergency Medicine, United States

• Zonghao Li, Emergency Medicine, China

• Janet Lioy, Neonatology, United States

• Horacio Locatelli, Emergency Medicine, Argentina

• David Lockey, Emergency Medicine, United Kingdom

• Ana Lopez Gutierrez, Anaesthesiology, Spain

• Stephen Lai, ENT Surgery, United States

• Wuhua Ma, Anesthesiology, China

• Stuart Marshall, Anaesthetist & Human Factors Specialist, Australia

• Greg Mastrapolo, Anesthesiologist Assistant, United States

• Jarrod Mosier, Emergency and Intensive Care Medicine, United States

• Mary Mushambi, Anaesthesia, United Kingdom

• Guillermo Navarro, Anesthesiology, Argentina

• Fiona Newman, Perianaesthesia Nursing, Australia

• Chris Nickson, Intensive Care Medicine and Emergency Medicine, Australia

• Jerry Nolan, Anaesthesia and Intensive Care, United Kingdom

• Reza Nouraei, ENT Surgery, United Kingdom

• David Olvera, Paramedic, United States

• Haydee Osses, Anesthesiology, Chile

• Anil Patel, Anaesthesia, United Kingdom

• Kathleen Quintero, Anesthesiology, Panama

• Adam Rehak, Anaesthesia, Australia

• Stefan Sabato, Paediatric anaesthesia, Australia

• Gautam Sachdev, Respiratory Therapist, United States

• Raphaela Schnittker, Human Factors Specialist, Australia

• Steven Shorrock, Human Factors Specialist, United Kingdom

• Lars Svarthaug, Nurse Anesthetist, Norway

• Toby St Clair, Paramedic, Australia

• Wendy Teoh, Anaesthesia, Singapore

• Arnd Timmermann, Anesthesiology, Germany

• Britta Ungern-Sternberg, Anaesthesia, Australia

• Ricardo Urtubia, Anesthesiology, Chile

• Oscar Valencia, Anaesthesiology, Spain

• David Vokes, Laryngology and Head & Neck Surgery, New Zealand

• Henry Wang, Emergency Medicine, United States

• Scott Weingart, Emergency Medicine, United States

• David Wong, Anesthesiology, Canada

• Ming-Zhang Zuo, Anesthesiology, China

Education Lead:

Adam Rehak, Anaesthesia, Medical Education & Simulation, Australia

Education Team:

Nicholas Chrimes, Anaesthesia, Medical Education & Simulation, Australia

Robert Greif, Anaesthesiology, Medical Education, Switzerland

Ellen O’Sullivan, Anaesthesiology, Ireland

Fiona Kelly, Anaesthesia & Human Factors, United Kingdom

Stuart Marshall, Anaesthesia, Medical Education, Simulation & Human Factors, Australia

Linda Beckmann, Anaesthesia, Australia (ANZCA/ASA/NZSA Airway Management Special Interest Group Representative)

Amy Berry, Adult Education, Learning & Instructional Design, Australia

Jon Gatward, Intensive Care, Medical Education, Simulation, Australia

Olly Snellgrove, Education, Australia

Gerry Khong, Anaesthesia, Australia

Other members are still being recruited to the education group.

The PUMA App will contain interactive digital versions of the PUMA algorithms, checklists and cognitive aids as well as additional airway planning tools. It will also include a tool for auditing airway outcomes and communicating the outcomes of airway management to future airway practitioners.

Both iOS & android versions of the app will be available.

A link to download the app will be posted on this page as soon as it becomes available.

Please use the form below to submit any questions or comments