Human factors and airway management: focus on the Swiss Airway Guidelines

Although decision-making in airway management is crucial for performance and outcomes, it often deteriorates in crisis situations. Studies suggest that human decision-making can be unreliable in such situations and must be supported to reduce reliance on exceptional human performance to ensure safety. Airway guidelines provide essential evidence-based information intended to maximize the likelihood of successful airway management. However, the linear, textual and inflexible design of most algorithms does not align with the naturalistic decision-making processes involved in clinical activity. They fail to consider how decisions are made under time pressure. A user-centered design that considers the cognitive challenges of high-stakes, time-pressured airway situations might be more effective in supporting decisions at the point-of-care. The science of human factors and ergonomics has become central to airway management, particularly in supporting human performance in highly demanding cognitive environments. It provides key strategies to support cognitive load, situational awareness, and ergonomic design, maximizing the advantages of new technologies by integrating them into workflows and promoting their intuitive use in stressful situations. Consequently, human factors and ergonomics might effectively promote collaborative decision-making at the sharp end. Guided by principles of human factors, the Fondation Latine des Voies Aériennes designed the Swiss Airway Guidelines, endorsed by the Swiss Society of Anesthesiology and Perioperative Medicine to provide clinicians with point of care guidance and support during airway management. They combine color- and icon-coded cognitive aids including key mnemonics aligned with an ergonomic airway cart. They also encompass a multimodal educational program and an implementation strategy. This system-based intervention aims to optimize decision-making in high-pressure, front-line context. By recognizing the cognitive capabilities and constraints of operators in crisis situations, it employs a holistic design approach to deliver comprehensive decision support. This narrative review uses the lens of human factors and ergonomics to describe the Swiss Airway Guidelines, drawing on the Systems Engineering Initiative for Patient Safety 3.0 and 101 frameworks. Our aim is to emphasize its importance in successfully managing airways, and to illustrate that reliable airway safety stems from systems designed to support human performance.