Abstract
Introduction:The Emergency Medicine (EM) Residency Review Committee stipulates that residents perform 3 cricothyrotomies in training but does not distinguish between those done on patients or via other training methods. This study was designed to determine how many cricothyrotomies residents have performed on living patients, the breadth and prevalence of alternative methods of instruction, and residents’ degree of comfort with performing the procedure unassisted.Methods:We utilized a web-based tool to survey EM residents nearing graduation and gathered data regarding the number of cricothyrotomies performed on living and deceased patients, animals, and models/simulators. Residents indicating experience with the procedure were asked additional questions as to the indication, supervision, and outcome of their most recent cricothyrotomy. We also collected data regarding experience with rescue airway devices, observation of cricothyrotomy, and comfort (“0–10” scale with “10” representing complete confidence) regarding the procedure.Results:Of 296 residents surveyed, 22.0% performed a cricothyrotomy on a living patient, and 51.6% had witnessed at least one performed. Those who completed a single cricothyrotomy reported a significantly greater level of confidence, 6.3 (95% confidence interval [CI] 5.7–7.0), than those who did none, 4.4 (95% CI 4.1–4.7), p<<0.001. Most respondents, 68.1%, had used the recently deceased to practice the technique, and those who had done so more than once reported higher confidence, 5.5 (95% 5.1–5.9), than those who had never done so, 4.1 (95% CI 3.7–4.5), p<<0.001. Residents who practiced cricothyrotomy on both simulators and the recently deceased expressed more confidence, 5.4 (95% CI 5.0–5.8), than those who used only simulators, 4.0 (95% CI 3.6–4.5), p<<0.001. Neither utilization of models, simulators, or animals, nor observance of others’ performance of the procedure independently affected reported confidence among residents.Conclusion:While prevalence of cricothyrotomy and reported comfort with the procedure remain low, performing the procedure on living or deceased patients increased residents’ confidence in undertaking an unassisted cricothyrotomy upon graduation in the population surveyed. There is evidence to show that multiple methods of instruction may yield the highest benefit, but further study is needed.
Highlights
The Emergency Medicine (EM) Residency Review Committee stipulates that residents perform 3 cricothyrotomies in training but does not distinguish between those done on patients or via other training methods
Of 296 residents surveyed, 22.0% performed a cricothyrotomy on a living patient, and 51.6% had witnessed at least one performed
68.1%, had used the recently deceased to practice the technique, and those who had done so more than once reported higher confidence, 5.5 (95% 5.1-5.9), than those who had never done so, 4.1, p
Summary
The Emergency Medicine (EM) Residency Review Committee stipulates that residents perform 3 cricothyrotomies in training but does not distinguish between those done on patients or via other training methods. Most adjunct devices possess the advantage that residents can use them during routine endotracheal intubations to gain proficiency in their use. This has the benefit of allowing trainees to better appreciate the subtleties of each instrument, its indications, and its drawbacks under more controlled circumstances. While the advent of models and simulators has afforded residents opportunities to hone their skills in the lab, even high fidelity models cannot reproduce the tissue consistency, bleeding, and anatomic variation that exist in human models.[3,5] Canine labs have been used, but anatomic differences between dogs and humans, expense, and concern over sacrifice of the animal are significant drawbacks.[6,7,8] Using the recently deceased to teach cricothyrotomy has been advocated by many as a way to provide residents with more realistic training experiences, but this approach raises concerns regarding the best means to respect the deceased and of kin and the necessity of and method by which consent may be obtained.[9,10,11]
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