Abstract
BackgroundRapid and safe airway management has always been of paramount importance in successful management of critically ill and injured patients in the emergency department. The purpose of our study was to determine success rates of bag-mask ventilation and tracheal intubation performed by emergency medicine residents before and after completing their anesthesiology curriculum.MethodsA prospective descriptive study was conducted at Nikoukari Hospital, a teaching hospital located in Tabriz, Iran. In a skills lab, a total number of 18 emergency medicine residents (post graduate year 1) were given traditional intubation and bag-mask ventilation instructions in a 36 hour course combined with mannequin practice. Later the residents were given the opportunity of receiving training on airway management in an operating room for a period of one month which was considered as an additional training program added to their Anesthesiology Curriculum. Residents were asked to ventilate and intubate 18 patients (Mallampati class I and ASA class I and II) in the operating room; both before and after completing this additional training program. Intubation achieved at first attempt within 20 seconds was considered successful. Successful bag-mask ventilation was defined as increase in ETCo2 to 20 mm Hg and back to baseline with a 3 L/min fresh gas-flow and the adjustable pressure limiting valve at 20 cm H2O. An attending anesthesiologist who was always present in the operating room during the induction of anesthesia confirmed the endotracheal intubation by direct laryngoscopy and capnography. Success rates were recorded and compared using McNemar, marginal homogeneity and paired t-Test tests in SPSS 15 software.ResultsBefore the additional training program in the operating room, the participants had intubation and bag-mask ventilation success rates of 27.7% (CI 0.07-0.49) and 16.6% (CI 0-0.34) respectively. After the additional training program in the operating room the success rates increased to 83.3% (CI 0.66-1) and 88.8% (CI 0.73-1), respectively. The differences in success rates were statistically significant (P = 0.002 and P = 0.0004, respectively).ConclusionsThe success rate of emergency medicine residents in airway management improved significantly after completing anesthesiology rotation. Anesthesiology rotations should be considered as an essential component of emergency medicine training programs. A collateral curriculum of this nature should also focus on the acquisition of skills in airway management.
Highlights
Rapid and safe airway management has always been of paramount importance in successful management of critically ill and injured patients in the emergency department
For the past 25 years, higher specialist trainees in A and E Medicine in the United Kingdom (UK) have been required to complete a minimum of 3-month secondment in anesthesia and intensive care [7]. During their training period in the skills lab and operating room trainees have an opportunity to develop specific learning objectives for airway management, our research provides them with the opportunity to focus on two of the most important skills: Bag mask ventilation and orotracheal intubation
Based on the results of Amarasinghe’s study, our research focused on assessment of the two most important and highly useful airway management skills; bagmask ventilation and orotracheal intubation
Summary
The purpose of our study was to determine success rates of bag-mask ventilation and tracheal intubation performed by emergency medicine residents before and after completing their anesthesiology curriculum. The current basic skills, listed in trainees’ logbooks seem to be insufficient. This indicates that a closer cooperation between emergency medicine and anesthesiology is required, starting from collegiate level and extending to departmental levels [3]. It is important not to try to turn EPs into anesthetists, but instead equip them with the skills they need for their particular environment and the problems they face [4]. Since concurrent failure of orotracheal intubation and mask ventilation can result in death or brain damage, these two basic techniques are the most important skills an anesthetist learns [5]
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