I have been passionate about learning and teaching airway management since I started practicing in the Emergency Department. As I learned more about the airway, I started to see a whole new world of knowledge to be explored. In fact, I felt a little indignant, because my college training had failed to teach me so much information necessary to manage the airway safely and responsibly in the emergency department. To fill the gap I perceived, I went to many national and international courses, and here are a few:
- XXIII Difficult Airway Course: Theoretical – practical approach (2017) – Hospital das Clinicas, Faculty of Medicine, University of São Paulo, HCFMUSP, Brazil. https://www.e-
inscricao.com/ anestesiologiausp/vad - The Difficult Airway Course: Emergency (2018) – SCHUMACHER Clinical Partners, United States https://www.
theairwaysite.com - The Difficult Airway Course: Emergency. Brazil Edition (2019) – SP https://omnicma.com
- Cadaver Lab (2019) – Dallas, United States https://bemedinspired.
com
Meanwhile, Dr. George Kovacs has been one of the biggest inspirations in my mission to learn and teach airway management, especially after I watched his spectacular lecture “The Psychologically Dangerous Airway.”
I learned he ran a course as a part of his “Airway Interventions & Management in Emergencies (AIME)” Project (http://aimeairway.ca). Learning from him became a big dream. And finally, in February, I managed to go to Halifax, Canada, to take the AIME Advanced course! http://aimeairway.ca
What to expect
The course offers some theoretical classes and plenty of space to practice with various devices. Each instructor supervises 5 or 6 trainees. All trainees rotate the stations to practice each skill on varying airway difficulties.
The highlights of the course include:
- Real-like Practice: “Nothing is closer to the human body than the human body itself.” Even the best mannequins fail to mimic human anatomy and conditions required to practice airway microskills, in terms of space, weight, and pressure. Therefore, participants of the AIME advanced course practice skills on cadavers donated to the Human Body Donation Program at Dalhousie. Learning with cadavers makes all the difference!
- Awake Intubation: This is one of the greatest works of Dr. Kovacs, who makes a live demonstration -on himself- of his technique and the materials he uses. Awake intubation is a simple technique, but it requires advanced knowledge. The main indication is anticipated anatomically and/or physiologically difficult airway in cooperative patients.
- Various devices: The course offers training with a spectrum of devices. In addition to hands-on training, instructors discuss the limitations of the devices and how to overcome them. For example, intubation with a fiberscope assisted by a video laryngoscope in the sedated patient.
- High-quality teaching materials: Case discussions in the course parallel real-life challenges and present viable solutions. The videos are excellent. All facilitate information exchange and learning.
Also, I must mention that all instructors are very receptive and fun, and interactions between students are excellent.
The only shortcoming of this course is that it lasts only one day.
So you may ask, “But is awake intubation worth learning even if I work in the Emergencies Departments in Brazil (or other resource-limited contexts for that matter)?” Well, reviewing the advanced airway anatomy and indications for interventions always help to improve practice. If where you work has a video device or fiberscope, you will benefit most from the course. If not (Most EDs in Brazil today don’t), taking the course is a good reason to ask your manager for buying affordable alternatives like VividTrac®, King Vision® or Airtraq®. Also, awake intubation may be performed with Direct Laryngoscopy; however, it does not make much sense to me considering the main indication: an anatomically difficult airway.
Finally, I recommend the AIME advanced course to everyone who wants to improve their skills and learn how to manage the airway in the awake patient.
If you are interested in airway management, here is another course I can recommend: PRACTICAL EMERGENCY AIRWAY MANAGEMENT https://www.ceme.
