Summary 
Advances in our understanding and practice of airway management necessitate contemporary guidelines for tracheal
intubation. The Difficult Airway Society (DAS) therefore produced recommendations to improve the efficacy and safety of
tracheal intubation. We conducted a systematic review and a three-round Delphi process to formulate multidisciplinary,
evidence-based, expert consensus recommendations. We invited 20 external experts to guide recommendations on
emergency front-of-neck airway and engaged DAS members and 16 international airway experts to provide feedback.
Twelve members of the guidelines group participated in 65 meetings over 3 years, and 1241 papers were included after a
systematic review. Sixty-five recommendations were made in relation to tracheal intubation. These included airway
assessment and planning; peroxygenation; postintubation care; rapid sequence induction and intubation; the physiologically difficult airway; obesity; human factors; point-of-care ultrasound; documentation; and education and training.
We maintain the concept of a linear algorithm encompassing tracheal intubation (Plan A); supraglottic airway device
ventilation (Plan B); facemask ventilation (Plan C); and emergency front-of-neck airway (Plan D). The recommendations
prioritise continuous oxygen delivery throughout airway management; maximising the likelihood of successful tracheal
intubation at the first attempt; confirmation of ventilation with waveform capnography; progressing through the algorithm in the event of failure; multidisciplinary teamwork; and ongoing education and training. These guidelines are
designed to support clinicians in delivering airway management that prioritises efficacy and safety. Overall, we
emphasise the importance of maximising the chances of success, rather than the avoidance and management of failure,
to improve outcomes for patients undergoing airway management.
Advances in our understanding and practice of airway management necessitate contemporary guidelines for tracheal
intubation. The Difficult Airway Society (DAS) therefore produced recommendations to improve the efficacy and safety of
tracheal intubation. We conducted a systematic review and a three-round Delphi process to formulate multidisciplinary,
evidence-based, expert consensus recommendations. We invited 20 external experts to guide recommendations on
emergency front-of-neck airway and engaged DAS members and 16 international airway experts to provide feedback.
Twelve members of the guidelines group participated in 65 meetings over 3 years, and 1241 papers were included after a
systematic review. Sixty-five recommendations were made in relation to tracheal intubation. These included airway
assessment and planning; peroxygenation; postintubation care; rapid sequence induction and intubation; the physiologically difficult airway; obesity; human factors; point-of-care ultrasound; documentation; and education and training.
We maintain the concept of a linear algorithm encompassing tracheal intubation (Plan A); supraglottic airway device
ventilation (Plan B); facemask ventilation (Plan C); and emergency front-of-neck airway (Plan D). The recommendations
prioritise continuous oxygen delivery throughout airway management; maximising the likelihood of successful tracheal
intubation at the first attempt; confirmation of ventilation with waveform capnography; progressing through the algorithm in the event of failure; multidisciplinary teamwork; and ongoing education and training. These guidelines are
designed to support clinicians in delivering airway management that prioritises efficacy and safety. Overall, we
emphasise the importance of maximising the chances of success, rather than the avoidance and management of failure,
to improve outcomes for patients undergoing airway management.
