Simulation of Adult Surgical Cricothyrotomy for Anesthesiology and Emergency Medicine Residents: Adapted for COVID-19

Abstract

Introduction: In a CICO (cannot intubate, cannot oxygenate) situation, anesthesiologists and acute care physicians must be able to perform an emergency surgical cricothyrotomy (front-of-neck airway procedure). CICOs are high-acuity situations with rare opportunities for safe practice. In COVID-19 airway management guidelines, bougie-assisted surgical cricothyrotomy is the recommended emergency strategy for CICO situations. Methods: We designed a 4-hour procedural simulation workshop on surgical cricothyrotomy to train 16 medical residents. We provided prerequisite readings, a lecture, and a videotaped demonstration. Two clinical scenarios introduced deliberate practice on partial-task neck simulators and fresh human cadavers. We segmented an evidence-based procedure and asked participants to verbalize the five steps of the procedure on multiple occasions. Results: Thirty-two residents who participated in the workshops were surveyed, with a 97% response rate (16 of 16 from anesthesiology, 15 of 16 from emergency medicine). Participants commented positively on the workshop's authenticity, its structure, the quality of the feedback provided, and its perceived impact on improving skills in surgical cricothyrotomy. We analyzed narrative comments related to three domains: preparation for the procedure, performing the procedure, and maintaining the skills. Participants highlighted the importance of performing the procedure many times and mentioned the representativeness of fresh cadavers. Discussion: We developed a surgical cricothyrotomy simulation workshop for anesthesiology and emergency medicine residents. Residents in the two specialities uniformly appreciated its format and content. We identified common pitfalls when executing the procedure and provided practical tips and material to facilitate implementation, in particular to face the COVID-19 pandemic.

Health Care Simulation as a Training Tool for Epidemic Management

“…The study characteristics are presented in the Table 1. Most of the studies on simulation-based training were developed in response to SARS-CoV-2 (n = 117, 79.1%) 6–8,16–128 . Eighteen were motivated by Ebola outbreaks (12.2%), 129–146 7 by influenza (4.7%), 147–153 3 by MERS (2%), 154–156 and 3 by pandemics in general (2%) 157–159 …”

COVID-19 Pneumonia and Status Asthmaticus With Respiratory Failure in a Pediatric Patient: A Simulation for Emergency Medicine Providers

“…18 Prior COVID-19 educational materials have also included an overview of COVID-19 for medical students 12 or have focused on modifying prior educational materials or curricula for delivery in the setting of COVID-19 learning restrictions. 14,15 Our case is novel in presenting a simulation that addresses the combined management of a pediatric patient with status asthmaticus and COVID-19 pneumonia with respiratory failure while adhering to in-person COVID-19 clinical care and learning restrictions.…”

“…Prior educational curricula developed in the literature in response to COVID-19 include a medical student COVID-19 curriculum, 12 modules on how to use appropriate PPE, 13 bougie-assisted surgical cricothyrotomy for COVID-19 airway management, 14 and many modifications of previously created educational materials for implementation during the COVID-19 pandemic. 14,15 There are also many teaching curricula for status asthmaticus 16,17 or pneumonia 18 with respiratory failure published in MedEdPORTAL. However, there are no published curricula addressing the combined management of a pediatric patient with status asthmaticus and COVID-19 pneumonia with respiratory failure with any teaching modality, and none that also incorporate PPE usage.…”

Cricothyrotomy in Acute Upper Gastrointestinal Bleed: A Difficult Airway Simulation Case for Anesthesiology Residents

“… 17 One simulation workshop focused on bougie-assisted surgical cricothyrotomy in 16 anesthesiology residents, with a self-assessed improvement of skill from a mean of −1.1 to 2.9 on an 11-point Likert-type scale (−5 = very bad, 5 = excellent ). 18 The CICO (can't intubate, can't oxygenate) situation in a bleeding airway presents a unique challenge. Our simulation pairs a common UGIB presentation with an out-of-OR setting (ICU) and cricothyrotomy, targeting anesthesiology residents and their preoperative preparation, anesthetic induction plan in a bleeding airway, and management of intraoperative complications including appropriate use of the difficult airway algorithm leading to surgical airway access.…”