We read with interest Dr. Dutton’s case report from the Anesthesia Quality Institute’s Anesthesia Incident Reporting System in the October 2013 ASA NEWSLETTER. The case highlights critical content that is of interest to all clinicians. Considering recent developments in invasive airway management challenges, we praise Dr. Dutton for publication of this case.

The 2013 ASA Difficult Airway Management Algorithm update recommends an assessment of the likelihood and anticipated clinical impact of difficult surgical airway access.

Percutaneous/surgical cricothyrotomy or tracheostomy remains the final step for obtaining an emergent airway in a failed “cannot intubate, cannot ventilate” (CICV) scenario. Nonetheless, the emergency surgical airway remains a rare and critical clinical procedure, the performance of which has a high complication rate.

The CICV scenario neglects to mention a key point we wish to emphasize: accurate identification of the...

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