Difficult Airway Simulator Intubation Success Rates Using Commission on Accreditation of Medical Transport Systems Training Standards

Abstract

Objectives This study was undertaken to evaluate difficult airway simulator intubation success rates using Commission on Accreditation of Medical Transport Systems (CAMTS) initial and maintenance intubation training standards on transport-RN novice intubators over a 1-year period. Methods Twelve transport nurses were blinded to and randomly assigned five or six of 64 different difficult airway simulator scenarios. Intubation success rates were measured 1 month before training, 1 month after training, and 1 year later, following CAMTS initial and maintenance intubation standards. Outcome measurements included first attempt intubation rate, overall intubation success rate, number of attempts to intubation, time per attempt, time to intubation, and time between attempts. During the study, participants received no additional training or opportunities to intubate. Results First-attempt intubation rates significantly improved (P 5 .022) from 19% 1 month before training to 36% 1 month after training, but did not significantly change (P > .999) 1 year later following CAMTS maintenance standards (34%). Mean cumulative success rates did not significantly improve after four attempts or after 3.5 minutes. The overall mean time per attempt and time between attempts declined with subsequent intubation attempts. Conclusions Using initial and maintenance CAMTS standards, simulator difficult airway intubation success rates are low in novice intubators. Our results suggest that one intubation/quarter may be enough to maintain difficult airway intubation success rates. Training significantly improves intubation rates. Little advantage occurs in intubation rates after four attempts or 3.5 minutes.