Abstract
Purpose: Emergency invasive airway access is necessary when a provider encounters a “can’t intubate, can’t ventilate” situation where non-invasive techniques fail. Regardless of advanced airway training, a cricothyrotomy is easier, faster, and associated with less bleeding when compared to a tracheotomy. The knowledge, confidence, and procedural ability of anesthesia residents in performing a cricothyrotomy were assessed. Methods: A 2014 IRB approval was obtained. After successful intubation, anesthesia residents were provided a brief clinical vignette where the only viable option was emergency invasive airway access. They were given a marking pen and asked to perform a mock cricothyrotomy. A multimedia educational program illustrating anatomy, procedural details, and alternate procedures was subsequently provided. At least 4 weeks later, the residents were again presented with the opportunity to participate. Results: Nine residents consented to participate before and 18 after the educational component. There was no difference between the patients used in each group. When adjusted for number of years in training and size of the patient, there was no difference in accuracy between the pre- and post- intervention groups. The educational program produced a statistically significant procedural time improvement for all participants. There was improvement in time for normal and overweight patients, with a more significant improvement for overweight patients. Both junior and senior level residents were faster without statistical difference between the two. Conclusions: A knowledge and confidence deficit in emergency invasive airway management exists; directed education results in improved procedural timing, especially with overweight patients.
Highlights
The American Society of Anesthesiologists developed a difficult airway algorithm to assist in the management of patients with complex airway needs [1]
Our hypothesis was that advanced anesthesia training would result in improved performance of a cricothyrotomy and that multimedia education would improve both accuracy and time to completion
A multimedia educational program including PowerPoint presentation and videos illustrating anatomy, procedural details, and alternate procedures like retrograde intubation was provided to all anesthesia residents, regardless of their decision to participate in the study
Summary
The American Society of Anesthesiologists developed a difficult airway algorithm to assist in the management of patients with complex airway needs [1]. When a provider encounters a “can’t intubate, can’t ventilate” situation where non-invasive techniques fail to provide ventilation, emergency invasive airway access including retrograde intubation, cricothyrotomy, and tracheotomy is necessary. For providers without advanced surgical training, a cricothyrotomy is easier, associated with less bleeding, and requires less surgical time when compared to tracheotomy [2]. The success rate of cricothyrotomy is between 87%-100% [3] and is an essential tool for any provider who manages the airway. According to the Goals and Objectives for anesthesia trainees, they must be proficient in all manner of difficult airway management. These objectives include senior residents being able to perform bedside percutaneous tracheotomies. Regardless of advanced airway training, a cricothyrotomy is preferable
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