Introduction to the Vortex:


Dr Nicholas Chrimes, FANZCA

Specialist Anaesthetist

Download the free e-book outlining the Vortex Approach. Available in a variety of formats to suit all computers, tablets, smartphones & e-readers.

Dr Peter Fritz, FACEM

Emergency Physician & Retrieval Specialist

Cognitive Tool

© Copyright Nicholas Chrimes & Peter Fritz, 2013. Vortex materials on this site are distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License  which permits use without alteration for non-commercial clinical or educational purposes with proper citation of the authors & copyright holders of the original work. No derivative works. For commercial use please contact the authors.

The authors would like to recognise Monash Simulation in supporting the development of the “Vortex Approach”.

Download the Vortex Cognitive Tool for use in your clinical area.

Overview The Vortex is a “high acuity implementation tool” - simple enough to be recalled in a crisis and flexible enough to be used in any context. Our philosophy is to train staff for management of the unanticipated difficult airway in the same manner we train them to manage cardiac arrest - using a single simple & universally applicable template that is taught to all staff likely to be involved in managing the crisis - irrespective of critical care discipline and of whether they are from a medical, nursing or paramedical background.

Emergency Surgical Airway (ESA) Status

See how a modified version of Scott Weingart’s CriCon concept can be integrated into the Vortex approach in an attempt to improve the practical & psychological preparedness of clinicians to perform an emergency surgical airway.


Vortex Optimisation “Training Matrix”

Download this teaching tool to assist training your staff in the specific interventions available for airway optimisation under the 5 general headings for each non-surgical airway technique.

All educational materials may be reproduced with acknowledgement of the original authors. The authors have no financial interest in the Vortex Approach or related materials.


Clinical use of the Vortex Approach is reported in a letter to the British Journal of Anaesthesia Br. J. Anaesth. (2014) 112 (4): 773-774


Vortex Airway Management Checklist

Designed to be used by any discipline, in any context requiring planned airway management, this tool provides a “pre-flight checklist” which prompts confirmation of key aspects of safe airway management prior to induction and specifically reinforces the Vortex Approach template during the preparation phase.

Ideally the Vortex Airway Checklist should be laminated “back to back” with the Vortex Cognitive Tool on the opposite side.

The aim is that by reinforcing the Vortex Approach format during routine preparation, this will facilitate its implementation when a difficult airway is encountered. It is also hoped that provision of a common checklist for use across different critical care specialities will facilitate development of a shared mental model for airway preparation and improve teamwork in situations when these groups come together.

The accompanying instruction page is intended as a reference resource only and is not for clinical use. Clinicians using the checklist  should have prior familiarity with the contents of the instruction page and be part of a team trained in advanced airway management.

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The live action segments of the “Vortex in Action” videos were produced by Monash Simulation and provided as open source intellectual property.

Neither Monash Simulation nor Monash Health are affiliated with

The Vortex Approach is recommended by the Australian & New Zealand College of Anaesthetists CPD Committee as an educational resource for the CICO Emergency Response Module.

Nicholas Chrimes discusses the rationale behind the Vortex Approach in this letter ot the British Journal of Anaesthesia  Br. J. Anaesth. (2015) 115 (1): 148-149

iPad Training App

Download the free iPad app to train your team in use of the Vortex Approach.

William Rosenblatt [Professor of Anesthesiology and Surgery (Otolaryngology) at Yale University School of Medicine] explains the relationship of the Vortex Approach to the conventional algorithms and its role in facilitating transition to emergency surgical airway in Anesthesiology News

The Elaine Bromiley Case: A real-time simulated reconstruction of the known events of real case in which human factors impacted on the management of an unanticipated difficult airway in an otherwise healthy woman undergoing elective surgery.

The case highlights the types of basic errors which can occur, even to teams of competent airway clinicians, in situations of stress. It is these difficulties in effectively implementing failed airway management strategies, that the Vortex Approach seeks to assist in overcoming.

Concerns with the Vortex: In this presentation, Nicholas Chrimes addresses common concerns and criticisms made of the Vortex Approach

What If? Teamwork in Emergency Airway Management: Using a context identical to that of the Elaine Bromiley case as a starting point, this video speculates on how a variety of teamwork interventions, including use of the Vortex Approach and the Emergency Surgical Airway Status, might have influenced the course of events.

The Vortex in Action: Simulated enactments of clinical use of the Vortex Approach

2015 DAS Guidelines acknowledge Vortex Approach as a tool for “real time” use during an evolving airway crisis.

Update to the Vortex Approach

A second edition of the Vortex Approach e-book is due for publication in May 2016 along with a new website and cognitive tool. The updated cognitive tool will include significant enhancements without changing the overall principles and simplicity of the Vortex Approach.

One of the changes will be substitution of the term “CICO Rescue” for “emergency surgical airway”. Currently there is no consensus on the terminology for this critical emergency procedure. The existing terms (emergency surgical airway, cricothyroidotomy, emergency front-of-neck access, infraglottic rescue, etc) vary in their simplicity, specificity and clarity - as well as their potential psychological impact on a clinician’s “willingness to act in a can’t intubate, can’t oxygenate (CICO) situation. For example many clinicians do not consider scalpel techniques to be “surgical” (a perspective supported by the terminology used in the 2015 DAS guidelines). This ambiguity over what constitutes surgical/non-surgical techniques combined with the potential that the term “surgical” may make the procedure more intimidating for non-surgeons makes this terminology less than ideal. The recently proposed “front-of-neck access” in the recent DAS guidelines, whilst non-initimidating is not an airway specific term and could conceivably be confused with central venous access. The Vortex Approach proposes use of the umbrella term “CICO Rescue” for all emergency techniques to resolve the CICO situation - regardless of whether performed using cannula/scalpel or whether access is obtained at the cricothyroid membrane or trachea.

The new Vortex implementation tool will also minimise the amount of text to enhance the visual nature of the tool. In addition it will extend the Green Zone concept to help improve decision making in situations when alveolar oxygen delivery has been achieved to avoid airway clinicians converting the can oxygenate into the can’t oxygenate situation.