Project for Universal Airway Management (PUMA) Includes The Difficult Airway Course Faculty

December 4, 2018

Several faculty members from The Difficult Airway Course have the privilege of working on the Project for Universal Airway Management (PUMA).

Drs. J. Adam Law and John Sakles are part of a team working to create universal guidelines for airway management practices around the globe. Fellow faculty members Drs. Laura Duggan, Darren Braude and Jarrod Mosier serve on PUMA’s advisory group.

Currently, several countries, including the United States, Canada, the United Kingdom, France, Germany, Italy and India have their own unique published guidelines and algorithms for airway management. PUMA’s goal is to develop recommendations that everyone across all countries and specialties can follow. The organization aims to “reflect, as much as possible, the consensus of existing published airway guidelines,” so that these common recommendations can be applied no matter where in the hospital or the world a clinician is practicing.

Dr. Law, Course Director for The Difficult Airway Course: Anesthesia, is one of four executive members of the project. Designed to cross borders and specialties, he hopes the guidelines will help with teaching airway management.

“As someone who educates in several countries, I don’t always know whose guidelines to use. For example, when in Canada, should I teach the Canadian guidelines, or the higher-profile American Society of Anesthesiologists’ or the UK’s Difficult Airway Society guidelines?”

In addition to creating guidelines that can be practiced everywhere, Dr. Law argues that it’s equally important to develop guidelines that can be practiced by everyone.

“Many of the existing guidelines are published by anesthesiologists for anesthesiologists. But other groups manage airways as well, including emergency medicine and intensive care clinicians. That’s why it would be great to have something truly universal.”

PUMA guidelines would also be applicable to countries currently lacking their own guidelines. For these locations, the PUMA recommendations could save them from having to build a document from scratch.

For countries already having their own guidelines, Dr. Law acknowledges that uptake of the PUMA guidelines may be slow. But if PUMA succeeds in their objectives, he knows he will be happy to recommend their guidelines.

“We plan to keep the PUMA guidelines a living document,” he says. “Rather than simply updating them at five or ten year intervals as with traditional guidelines, we’ll be able to add to or change our recommendations as new discoveries come in.”

PUMA hopes to have a draft document available for public viewing in 2018, and then aims to have a final version published in a major journal so it can be easily accessed by all medical professionals.

Visit to learn more about PUMA.

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