Role of contextualizing a crisis scenario on the performance of a cricothyrotomy procedural task

Abstract

Purpose Simulation is an important alternative to evaluate cricothyrotomy, a rare life-saving procedure. This crossover study aimed to determine whether contextualization of a crisis scenario would impact the performance of a cricothyrotomy procedural task. Methods Sixty-five anesthesia assistants and emergency medicine and anesthesia residents underwent a teaching session in surgical cricothyrotomy using one of two sets of cricothyrotomy kits: the Portex 6.0 and Melker 3.5 (n = 32) or the Portex 6.0 and Melker 5.0 (n = 33). Within six weeks following the session, the participants performed cricothyrotomies on a full-body patient mannequin simulator coupled with a porcine larynx (tissuemannequin simulator) using the assigned two kits in a ''cannot intubate, cannot ventilate'' (CICV) contextualized scenario (CS) and in a CICV verbalized non-contextualized scenario (NCS). Each participant performed a total of four cricothyrotomies using the two kits in the two scenarios. The primary outcome measure was insertion time, and secondary outcome measures were severity of injuries and failure rate. Outcome measures were compared between scenarios for each kit. Results Mean (SD) insertion time for a successful cricothyrotomy was not significantly different between NCS and CS for the Melker 3.5 [83.0 (45.0) sec vs 63.3 (36.1) sec, respectively; P = 0.96; mean difference (MD), 19.7 sec; 95% confidence interval (CI), -1.9 to 41.3], the Melker 5.0 [86.5 (36.8) sec vs 107.1 (55.6) sec, respectively; P = 0.11; MD, -20.6 sec; 95% CI, -44.9 to 3.7], and the Portex 6.0 [59.5 (35.5) sec vs 59.0 (35.0) sec, respectively; P = 0.95; MD, 0.5 sec; 95% CI, -13.2 to 14.2]. Failure rate and severity of injuries, measured as mean average injury score for each kit, were also similar between scenarios. Conclusions Contextualization of a crisis scenario did not affect the performance of a cricothyrotomy procedural task on a tissue-mannequin simulator. These findings may have implications when considering the feasibility and cost-effectiveness for assessing the performance of cricothyrotomy procedural tasks. RésuméObjectif La simulation est une alternative importante pour évaluer la cricothyrotomie, une intervention de sauvetage rare. Cette étude croisée avait pour objectif de déterminer si la mise en contexte d'un scénario de crise avait un impact sur la performance d'une tâche procédurale de cricothyrotomie.Author contributions Kong E. You-Ten designed the study, conducted the study, analyzed the data, and wrote the manuscript. Catherine Wong helped analyze the data and write the manuscript. Catherine Wong, Cristian Arzola, Jessica Cheung, and Naveed Siddiqui helped conduct the study. Catherine Wong, Cristian Arzola, Jessica Cheung, Naveed Siddiqui, Zeev Friedman, and Sev Perelman helped review the manuscript. Zeev Friedman and Sev Perelman helped design the study.

Critical Appraisal of Emergency Medicine Educational Research: The Best Publications of 2015

“…A total of 434 papers and abstracts satisfied the search criteria, and 61 papers met the inclusion criteria . The authors scored these 61 manuscripts, and the 10 highest scoring quantitative and two qualitative articles are reviewed below, in alphabetical order by first author's last name.…”

“…demonstrated that studies that were funded tended to be of higher quality when assessed on a validated tool. In 2015, 12 studies (20%) were funded, one received federal funding, two received foundational funding, and eight received support from an institution or unspecified organization . Four of the 12 highlighted articles (33%) this year were funded research …”

Determining the amount of training needed for competency of anesthesia trainees in ultrasonographic identification of the cricothyroid membrane

“…We neither created the stressful environment of a difficult airway situation nor assess directly the cricothyrotomy procedure. However, we previously demonstrated that the context of a stressful simulated airway crisis scenario did not affect the cricothyrotomy procedure [27]. …”

Updating our approach to the difficult and failed airway: time to “stop and think”

“…20 While no panacea, individuals and teams can be immunized with education, boosted by volume-based competence, and augmented through simulation. [23][24][25] In the longer term, we will need to ''stop and think'' about the challenges of translating guidelines into meaningful change. There can be good reasons to hold onto the old ways, and hence, time should be allowed for challenge and debate.…”

“…20 Bien qu'il ne s'agisse pas d'une panacée, les individus et les équipes peuvent être immunisées par l'éducation, encouragées par une compétence acquise grâce au volume d'activité et renforcées par des simulations. [23][24][25] À plus long terme, nous devrons « arrêter et réfléchir » aux défis de la traduction de ces lignes directrices en changements significatifs. Il peut y avoir de bonnes raisons pour nous accrocher à nos vieilles habitudes et il faut donc laisser du temps pour relever les défis et en débattre.…”