Effects of prior exposure to a visual airway cognitive aid on decision-making in a simulated airway emergency

Abstract

BACKGROUND Decision-making deficits in airway emergencies have led to adverse patient outcomes. A cognitive aid would assist clinicians through critical decision-making steps, preventing key action omission. OBJECTIVE We aimed to investigate the effects of a visual airway cognitive aid on decision-making in a simulated airway emergency scenario. DESIGN Randomised controlled study. SETTING Single-institution, tertiary-level hospital in Toronto, Canada from September 2017 to March 2019. PARTICIPANTS Teams consisting of a participant anaesthesia resident, nurse and respiratory therapist were randomised to intervention (N = 20 teams) and control groups (N = 20 teams). INTERVENTION Participants in both groups received a 15-min didactic session on crisis resource management which included teamwork communication and the concepts of cognitive aids for the management of nonairway and airway critical events. Only participants in the intervention group were familiarised, oriented and instructed on a visual airway cognitive aid that was developed for this study. Within 1 to 4 weeks after the teaching session, teams were video-recorded managing a simulated ‘cannot intubate-cannot oxygenate’ scenario with the aid displayed in the simulation centre. MAIN OUTCOME MEASURES Decision-making time to perform a front-of-neck access (FONA), airway checklist actions, teamwork performances and a postscenario questionnaire. RESULTS Both groups performed similar key airway actions; however, the intervention group took a shorter decision-making time than the control group to perform a FONA after a last action [mean ± SD, 80.9 ± 54.5 vs. 122.2 ± 55.7 s; difference (95% CI) −41.2 (−76.5 to −6.0) s, P = 0.023]. Furthermore, the intervention group used the aid more than the control group (63.0 vs. 28.1%, P < 0.001). Total time of scenario completion, action checklist and teamwork performances scores were similar between groups. CONCLUSIONS Prior exposure and teaching of a visual airway cognitive aid improved decision-making time to perform a FONA during a simulated airway emergency.

Use of Cognitive Aids to Augment Point of Care Hemorrhage Control Skills in Laypersons

“…Furthermore, while not previously examined in this context, if instructional aids are to be included in public kits in the future, it is essential to consider if their efficacy depends on bystanders being familiarized with them during their actual B-Con training. 16 Our results suggest that a 10-min primer during the B-Con course could significantly benefit tourniquet skills regardless of the type of aid used, as shown elsewhere. 16…”

“…16 Our results suggest that a 10-min primer during the B-Con course could significantly benefit tourniquet skills regardless of the type of aid used, as shown elsewhere. 16…”

“…Furthermore, while not previously examined in this context, if instructional aids are to be included in public kits in the future, it is essential to consider if their efficacy depends on bystanders being familiarized with them during their actual B-Con training. 16 Our results suggest that a 10-min primer during the B-Con course could significantly benefit tourniquet skills regardless of the type of aid used, as shown elsewhere. 16 Despite the benefits seen from using an aid in varying formats in the current study, attending the B-Con course generally improved hemorrhage control skills in both situational awareness and tourniquet or wound packing performance compared with other groups.…”

“…16 Our results suggest that a 10-min primer during the B-Con course could significantly benefit tourniquet skills regardless of the type of aid used, as shown elsewhere. 16 Despite the benefits seen from using an aid in varying formats in the current study, attending the B-Con course generally improved hemorrhage control skills in both situational awareness and tourniquet or wound packing performance compared with other groups. This suggests that regardless of having visual or video-audio instruction, an essential aspect of teaching bleeding control skills remains from being able to practice with the tourniquet before testing.…”

“…The specific type of instructional aid, the method of delivery, and how participants are familiarized (“primed”) with the aid are essential elements that may influence the efficacy of an aid in an emergency scenario. 6,8,16−18 The current work found that the most optimal format of an instructional aid for tourniquet performance is for bystanders who had attended the B-Con class (OR, 12.67; P = 9.3 × 10 −11 ), used a visual-audio aid (OR, 1.96; P = 0.04), and were primed on that aid before using it (OR; 2.23; P = 0.01). Specifically, in this format with a visual-audio aid, 77% of laypersons could correctly apply a tourniquet with a third of the number of errors.…”