Effect of Simulation on Compliance With Difficult Airway Management Algorithms, Technical Ability, and Skills Retention for Emergency Cricothyrotomy

Abstract

T he effectiveness of simulation is rarely evaluated. The impact of a short-training course on the ability of anesthesiology residents to comply with current difficult airway management guidelines was assessed. Twenty-seven third-year anesthesiology residents were evaluated on a simulator in a "can't intubate, can't ventilate" (CICV) scenario before the training (the pretest) and then randomly at 3, 6, or 12 months after training (the posttest). The scenario was constructed so that the resident was prompted to perform a cricothyrotomy. Adherence with airway management guidelines and the duration of the cricothyrotomy and technical quality were assessed as a checklist score (0-10) and a global rating scale (7-35). After training, all 27 residents complied with the airway management guidelines compared with 17 (63%) in the pretest (P < 0.005). In the pretest and the 3-, 6-, and 12-month posttests, the median (range) duration of cricothyrotomy was 117 seconds (70-184 seconds), 69 seconds (43-97 seconds), 52 seconds (43-76 seconds), and 62 seconds (43-74 seconds) versus the pretest (P < 0.0001). The median (range) checklist score was 3 (0-7), 8 (8-10), 9 (6-10) and 9 (4-10) versus the pretest (P < 0.0001). The median (range) global rating scale was 12 (7-22), 30 (20-35), 33 (23-35), and 31 (18-33) versus in the pretest (P < 0.0001). There were no marked differences between performance levels attained in the 3-, 6-, and 12-month posttests. The training session markedly improved the resident' compliance with guidelines and their performance of cricothyrotomy.

Airway Management in Ambulatory Anesthesia

“…They work off the principle of having multiple back-up plans in the event of ''Plan A'' failing. They should be studied in advance and practice of techniques such as simulator training can be very useful in improving success rates [69]. The early identification of the emergency situation, calling for help early, and changing technique or equipment in a timely fashion are crucial in the management of the unexpected difficult airway.…”

“…Plans should be in place in the eventuality of this occurring to further manage patients either by ENT or Head and Neck surgeons or by critical care physicians skilled in this technique. This is a very infrequent event, and thus advance training and frequent updating of experience are required [15,69]. There are multiple cricothyroid kits on the market (e.g., the Rusch Ò QuickTrach Ò Kit, Teleflex Inc, North Carolina).…”

Establishment and Application of Cricothyrotomy In Vivo

“…The incidence of CICO emergency airway has been signi cantly reduced in recent years due to the rapid development of medical technology and medical equipment, especially the wide application of various airway management tools such as video laryngoscope, laryngeal mask, and exible electronic endoscopic [2] . In routine clinical practice, emergencies requiring cricothyrotomy are infrequent, and most anesthesiologists are relatively inexperienced in performing the procedure [3] .…”