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The OxygeNATION Cycle

The first important concept

Not getting it right on the first try is not important, it’s what you do next that counts. You need a strategy for each upper airway lifeline (bvm, supraglottic, and endotracheal tube) so that you can rapidly cycle through them and optimize your performance.

What happens when this is as good as its gonna get
(and it’s not good enough)

“The term ‘best effort’ is used by the Vortex Approach to describe the circumstance in which all viable strategies to facilitate success at entering the Green Zone via a given lifeline have been implemented. Up to three attempts (+/- a ‘gamechanger’ – see below), each incorporating additional optimisations that have not previously been implemented, are permitted to complete a best effort. The specific optimisations employed and the number of attempts that are appropriate to achieve a best effort are context dependent decisions, to be made by the airway operator within the confines of the principles set out by the Vortex Approach. 

If following a completed best effort at a particular lifeline, alveolar oxygen delivery has not been achieved, then no further attempts at that lifeline should occur. Efforts should instead focus on establishing alveolar oxygen delivery via an alternate lifeline – or on initiating Neck Rescue if all three lifelines have been unsuccessful.  

The Vortex Approach

Curated FOAMED resource

Tied to the successful deployment of your three essential upper airway lifelines. (1 – the bag valve mask 2 – the supraglottic airway 3 – the endotracheal tube) are the twin concepts of optimization and best effort. This video is a more detailed discussion of them as part of the vortex approach.

clinical pearl

Don’t get locked in. Have a plan to prepare for stress and focus lock.


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The digital space

For when you can’t be with us in person, or you want to see the full digital learning space for this topic you can always join us here.

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