Background: Front-of-neck airway rescue in a cannot intubate, cannot oxygenate (CICO) scenario with impalpable anatomy is particularly challenging. Several techniques have been described based on a midline vertical neck incision with subsequent finger dissection, followed by either a cannula or scalpel puncture of the now palpated airway. We explored whether the speed of rescue oxygenation differs between these techniques. Methods: In a high-fidelity simulation of a CICO scenario in anaesthetised Merino sheep with impalpable front-of-neck anatomy, 35 consecutive eligible participants undergoing airway training performed scalpelefingerecannula and scalpelefingerebougie in a random order. The primary outcome was time from airway palpation to first oxygen delivery. Data, were analysed with Cox proportional hazards. Results: Scalpelefingerecannula was associated with shorter time to first oxygen delivery on univariate (hazard ratio [HR]¼ 11.37; 95% confidence interval [CI], 5.14e25.13; P<0.001) and multivariate (HR¼8.87; 95% CI, 4.31e18.18; P<0.001) analyses. In the multivariable model, consultant grade was also associated with quicker first oxygen delivery compared with registrar grade (HR¼3.28; 95% CI, 1.36e7.95; P¼0.008). With scalpelefingerecannula, successful oxygen delivery within 3 min of CICO declaration and 2 attempts was more frequent; 97% vs 63%, P<0.001. In analyses of successful cases only, scalpelefingerecannula resulted in earlier improvement in arterial oxygen saturations (e25 s; 95% CI, e35 to e15; P<0.001), but a longer time to first capnography reading (þ89 s; 95% CI, 69 to 110; P<0.001). No major complications occurred in either arm. Conclusions: The scalpelefingerecannula technique was associated with superior oxygen delivery performance during a simulated CICO scenario in sheep with impalpable front-of-neck anatomy.

It is possible that educating medical students about the dangers of online social media, and how to use it appropriately, could be worthwhile.

High fidelity simulation allows training of foundation doctors in a safe, structured environment. We explored the perceived impact of such training on subsequent clinical practice. 82 doctors attended and 52% responded to a follow up questionnaire sent two months after their training. 88% felt better able to manage the acutely ill patient than they did before their training. All cited simulation training as a reason for this and 44% felt simulation training was the main contributor. The remainder cited clinical experience as the main contributor. 53% gave real clinical examples where they applied skills attributed to simulation training. Doctors reflected positively on simulation training sometime after the experience, demonstrated transference of learnt skills and felt more confident at work.

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