The Effect of High-Fidelity Simulation on the Confidence and Decision-Making Ability of Anaesthesia Trainees in Managing Subsequent Simulated ‘Can't Intubate, Can't Oxygenate’ scenarios

Abstract

The decision to attempt a percutaneous airway in a recognised 'Can't Intubate, Can't Oxygenate' (CICO) situation may occur too late to avoid a poor outcome. Our study was designed to investigate the effect of high-fidelity simulation on the confidence and decision-making ability of anaesthesia trainees in managing CICO scenarios in subsequent simulation. Nine anaesthesia trainees from Logan Hospital participated. Pre-study questionnaires surveying confidence levels in various anaesthetic crises were completed. All participants underwent an education session based on algorithms developed for failed intubation and ventilation, and techniques for securing percutaneous airway access. However, only four of the nine participated in a high-fidelity simulation session. All nine participants were then filmed during 'mini-simulation' assessment sessions and completed post-study questionnaires identical to those at the commencement of the study. The four trainees who had undertaken the initial high-fidelity simulation had a lower median time to laryngeal mask airway attempt (60 versus 115 seconds) and time to percutaneous airway attempt (111 versus 172 seconds) in the subsequent simulation. The median number of deviations from the Difficult Airway Society algorithm was 0 for the simulation group compared to 1 for the non-simulation group. This small study suggests that high-fidelity simulation shortens the decision-making time of anaesthesia trainees in subsequent simulated CICO scenarios. This observation warrants follow-up in larger prospective trials.