1
|
Kraemer LS, Lopreiato J, McMurray H, Jeyarajah T, Dampman R, Raiciulescu S, Capo Dosal G, Jaffe E, Switzer J, Bowyer M. Retention of En Route Cricothyroidotomy Skills in Novice Providers Following a Simulation-Based Mastery Learning Curriculum. Mil Med 2024:usae107. [PMID: 38651572 DOI: 10.1093/milmed/usae107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/15/2023] [Accepted: 03/03/2024] [Indexed: 04/25/2024] Open
Abstract
INTRODUCTION Surgical cricothyroidotomy (SC) is a vital skill that combat first responders must master as airway obstruction is the third most preventable cause of death on the battlefield. Degradation of skills over time is a known problem, and there is inadequate knowledge regarding the rate of SC skill retention. Our prior study showed that simulation-based mastery learning was effective in training 89 novices how to reliably perform an en route SC to mastery performance standards. This study aims to assess the durability of this skill by bringing participants back in 3 separate cohorts at 6, 12, or 24 months following the initial training to perform SC in the same test environment. MATERIALS AND METHODS This was a randomized prospective trial. Random cohorts of equal subjects who previously underwent SC simulation-based mastery learning training were selected to return at 6, 12, and 24 months to retest in the same en route medical evacuation (MEDEVAC) helicopter scenario. A total of 22, 14, and 10 subjects returned at 6, 12, and 24 months, respectively, due to Coronavirus-19 impacts and travel limitations. Participants in the 24-month cohort received a refresher training prior to retesting. All attempts were recorded and blindly graded using the same 10 item standardized SC checklist used in initial training. Our previous work found that mastery criteria for performing a SC were ≤40 seconds and completion of 9/10 items on the checklist. Outcome measures in this study were time to complete the procedure and percent of subjects who completed at least 9/10 items on the SC checklist. RESULTS There was an increase in time required to complete the procedure compared to initial training in all three retesting cohorts (initial: median 27.50, interquartile range 25.38-31.07 seconds; 6 months: median 36.33, interquartile range 31.59-55.22 seconds; 12 months: median 49.50, interquartile range 41.75-60.75 seconds; 24 months: median 38.79, interquartile range 30.20-53.08 seconds; P < .0001, P < .0001, P = .0039). There was a decline in median value checklist scores compared to initial training in the 6- and 12-month retesting cohorts (initial: median 10.00/10, interquartile range 9.50-10.00; 6 months: median 8.00/10, interquartile range 6.75-9.00; 12 months: median 8.00/10, interquartile range 6.75-9.25; P < .0001, P < .001). There was no difference in median checklist scores between the initial and 24-month retesting scenario (initial: median 10.00/10, interquartile range 9.50-10.00; 24 months: 10.00/10, interquartile range 9.00-10.00; P= .125). There was a decrease in retention of skills as only 31.82% of subjects at 6 months and 14.29% at 12 months met the defined passing criteria of time to completion of ≤40 seconds and checklist score of ≥9/10. A brief refresher course several months prior to the 24-month cohort retesting greatly increased the retention of SC procedural skills, with 60% of subjects meeting the time and checklist criteria. CONCLUSIONS This study showed that the skill required to perform a SC after initial mastery training does decay significantly. A brief refresher course can help increase retention of skills. Based on our findings SC skills should be refreshed at a minimum of every 6 months to assure optimal proficiency.
Collapse
Affiliation(s)
- Laura S Kraemer
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- General Surgery Department, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Joseph Lopreiato
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Haana McMurray
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Ophthalmology Department, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
| | - Theepica Jeyarajah
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc (HJF), Bethesda, MD 20817, USA
| | - Rachel Dampman
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc (HJF), Bethesda, MD 20817, USA
| | - Sorana Raiciulescu
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Gerardo Capo Dosal
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Family Medicine Department, Madigan Army Medical Center, Tacoma, WA 98431, USA
| | - Edward Jaffe
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Anesthesiology Department, George Washington University, Washington, DC 20037, USA
| | - Julia Switzer
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Internal Medicine Department, JBSA-Fort Sam Houston, San Antonio, TX 78234-7823, USA
| | - Mark Bowyer
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| |
Collapse
|
2
|
Suzuki K, Yambe N, Hojo K, Komatsu Y, Serikawa M, Usami A. Anatomical morphometry for Cricothyrotomy puncture and incision. BMC Surg 2023; 23:198. [PMID: 37438728 DOI: 10.1186/s12893-023-02100-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/07/2023] [Indexed: 07/14/2023] Open
Abstract
PURPOSE Emergency surgical airway securing techniques include cricothyrotomy, puncture, and incision. While the instruments used for these methods vary in size, no index of laryngeal morphology exists to guide instrument selection. Therefore, we measured the morphology of the cricothyroid ligament in Japanese individuals and assessed its correlations with height. METHODS This retrospective study used 61 anatomical practice specimens. The cricothyroid ligament of the laryngeal area was dissected, and a frontal image was recorded. Next, images of the midsagittal sections of the larynx and trachea were recorded. The width and height of the cricothyroid ligament were measured from the frontal images, and the depth of the larynx and the angle to the lower edge of the cricothyroid plate were measured from the mid-sagittal cross-sectional images. The height was estimated from the tibial lengths of the specimens and statistically analyzed for correlations. RESULTS: The width and depth were significantly greater in males. Overall, there was a slight correlation between the results of each laryngeal measurement and estimated height for all items. CONCLUSION The morphology of cricothyrotomy revealed that the width and depth of the laryngeal area varied according to sex. Moreover, the results also showed a correlation with the estimated height. Thus, it is important to predict the morphology of the laryngeal area and cricothyroid ligament by considering factors such as patient sex, weight, and height.
Collapse
Affiliation(s)
- Kaiji Suzuki
- Department of Oral Functional Anatomy, Graduate School of Dentistry, Ohu University, Koriyama, Japan
| | - Naohito Yambe
- Community Medicine Support Dentistry, Ohu University Hospital, Koriyama, Japan
| | - Kentaro Hojo
- Department of Oral Anesthesia, School of Dentistry, Ohu University, Koriyama, Japan
| | - Yasunori Komatsu
- Department of Oral Anesthesia, School of Dentistry, Ohu University, Koriyama, Japan
| | - Masamitsu Serikawa
- Department of Morphological Biology, School of Dentistry, Ohu University, Koriyama, Japan
| | - Akinobu Usami
- Department of Morphological Biology, School of Dentistry, Ohu University, Koriyama, Japan.
| |
Collapse
|
3
|
Zagona-Prizio C, Pascoe MA, Corbisiero MF, Simon VC, Mann SE, Mayer KA, Maloney JP. Cadaveric emergency cricothyrotomy training for non-surgeons using a bronchoscopy-enhanced curriculum. PLoS One 2023; 18:e0282403. [PMID: 36952528 PMCID: PMC10035915 DOI: 10.1371/journal.pone.0282403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 02/07/2023] [Indexed: 03/25/2023] Open
Abstract
Background Emergency cricothyrotomy training for non-surgeons is important as rare “cannot intubate or oxygenate events” may occur multiple times in a provider’s career when surgical expertise is not immediately available. However, such training is highly variable and often infrequent, therefore, enhancing these experiences is important. Research question Is bronchoscopy-enhanced cricothyrotomy training in cadavers feasible, and what are the potential benefits provided by this innovation for trainees? Methods This study was performed during implementation of a new program to train non-surgeon providers on cadaveric donors on our campus. Standard training with an instructional video and live coaching was enhanced by bronchoscopic visualization of the trachea allowing participants to review their technique after performing scalpel and Seldinger-technique procedures, and to review their colleagues’ technique on live video. Feasibility was measured through assessing helpfulness for trainees, cost, setup time, quality of images, and operator needs. Footage from the bronchoscopy recordings was analyzed to assess puncture-to-tube time, safety errors, and evidence for a training effect within groups. Participants submitted pre- and post-session surveys assessing their levels of experience and gauging their confidence and anxiety with cricothyrotomies. Results The training program met feasibility criteria for low costs (<200 USD/donor), setup time (<30 minutes/donor), and operator needs (1/donor). Furthermore, all participants rated the cadaveric session as helpful. Participants demonstrated efficient technique, with a median puncture-to-tube time of 48.5 seconds. Bronchoscopy recordings from 24 analyzed videos revealed eight instances of sharp instruments puncturing the posterior tracheal wall (33% rate), and two instances of improper tube placement (8% rate). Sharp instruments reached potentially dangerous insertion depths beyond the midpoint of the anterior-posterior diameter of the trachea in 58.3% of videos. Bronchoscopic enhancement was rated as quite or extremely helpful for visualizing the trachea (83.3%) and to assess depth of instrumentation (91.7%). There was a significant average increase in confidence (64.4%, P<0.001) and average decrease in performance anxiety (-11.6%, P = 0.0328) after the session. A training effect was seem wherein the last trainee in each group had no posterior tracheal wall injuries. Interpretation Supplementing cadaveric emergent cricothyrotomy training programs with tracheal bronchoscopy is feasible, helpful to trainees, and meets prior documented times for efficient technique. Furthermore, it was successful in detecting technical errors that would have been missed in a standard training program. Bronchoscopic enhancement is a valuable addition to cricothyrotomy cadaveric training programs and may help avoid real-life complications.
Collapse
Affiliation(s)
- Caterina Zagona-Prizio
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America
| | - Michael A. Pascoe
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America
| | | | - Violette C. Simon
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America
| | - Scott E. Mann
- Department of Otolaryngology Head and Neck Surgery, University of Colorado, Aurora, CO, United States of America
- Department of Surgery, Denver Health Medical Center, Denver, CO, United States of America
| | - Katherine A. Mayer
- Department of Emergency Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America
| | - James P. Maloney
- Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America
- * E-mail:
| |
Collapse
|
4
|
Duan Q, Yang D, Gao H, Liu Q, Zhi J, Xu J, Xia W. Scalpel cricothyrotomy versus punctured cricothyrotomy in the context of the CICO crisis. A systematic review and Meta-analysis. Anaesth Crit Care Pain Med 2023; 42:101211. [PMID: 36871625 DOI: 10.1016/j.accpm.2023.101211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/14/2023] [Accepted: 02/25/2023] [Indexed: 03/07/2023]
Abstract
IMPORTANCE The preferential use of a scalpel (SCT) or puncture techniques (PCT) for cricothyrotomy remains a controversial topic. OBJECTIVE We performed a systematic review and meta-analysis comparing puncture cricothyrotomy with scalpel cricothyrotomy using overall success rate, first-time success rate, and time taken to perform the procedure as the primary outcome together with complications as a secondary outcome. EVIDENCE REVIEW Pubmed databases, EMBASE databases, MEDLINE, Google Scholar, and Cochrane Central Register of Controlled Trials, from 1980 to October 2022. FINDINGS A total of 32 studies were included in the systematic review and meta-analysis. It also showed that PCT was close to SCT in terms of overall success rate (82.2% vs. 82.6%, Odd Ratios OR = 0.91, [95%CI: 0.52-1.58], p = 0.74) as well as first-performance success rate (62.9% vs. 65.3%, OR = 0.52, [0.22-1.25], p = 0.15). PCT does not compare favorably with SCT in terms of required time for the procedure (the mean time required for PCT versus SCT incision in the intervention groups was 0.34 standard deviations higher (Mean Difference MD = 17.12, [3.37-30.87], p = 0.01) as well as complications (21.4% vs. 15.1%, Relative Risk RR = 1.49, [0.80-2.77], p = 0.21). CONCLUSIONS AND RELEVANCE The results show that SCT has an advantage over PCT in terms of time required for the procedure, while there is no difference in overall success rate, first-time success rate after training, and complications. The superiority of SCT may be the result of fewer and more reliable procedural steps. However, the level of evidence is low (GRADE).
Collapse
Affiliation(s)
- Qirui Duan
- Department of Anesthesia, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dong Yang
- Department of Anesthesia, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Huibin Gao
- Department of Anesthesia, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Quanle Liu
- Department of Anesthesia, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Juan Zhi
- Department of Anesthesia, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jin Xu
- Department of Anesthesia, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weipeng Xia
- Department of Anesthesia, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
5
|
Mallows JL, Tyler PA. Randomized controlled trial comparing an open surgical technique and a Seldinger technique for cricothyrotomy performed on a simulated airway. AEM EDUCATION AND TRAINING 2021; 5:e10699. [PMID: 34859169 PMCID: PMC8616178 DOI: 10.1002/aet2.10699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/20/2021] [Accepted: 09/28/2021] [Indexed: 05/25/2023]
Abstract
OBJECTIVES Emergency cricothyrotomy is a lifesaving procedure performed when intubation fails and oxygenation cannot occur. There are multiple techniques and kits to perform this procedure. However, current evidence does not provide a definitive answer as to which method is superior. Two techniques in common use are a surgical technique and a percutaneous Seldinger-based cricothyrotomy kit. The objective was to determine which of these two methods was quickest to perform and to determine which was most preferred by participants. METHODS A prospective randomized controlled crossover trial was conducted involving emergency physicians and trainees. Each participant performed both cricothyrotomy techniques in succession on an airway model, with the technique performed first being randomized for each participant. The primary outcome was time to first insufflation of the artificial lung. A survey was completed by participants asking their comfort with each technique on a 5-point scale from 1 (not at all comfortable) to 5 (very comfortable) and which technique they preferred. RESULTS Twenty-one emergency physicians and nine emergency medicine trainees were recruited. The surgical technique was performed the fastest, with a mean (±SD) time of 51.6 (±16.3) s versus 66.6 (±14.9) s for the Seldinger technique, with a statistically significant difference of 15.0 s (95% confidence interval = 8.5 to 21.5, p < 0.001). The surgical technique was rated the most comfortable to perform, with a median rating of 5 (interquartile range [IQR] = 4-5) versus 4 (IQR = 3-5) for the Seldinger technique. The surgical technique was most preferred by participants (80% vs 20%). CONCLUSION The surgical technique was the fastest to perform and was rated the most comfortable to perform and the most preferred technique.
Collapse
Affiliation(s)
- James L. Mallows
- Nepean HospitalKingswoodNew South WalesAustralia
- Sydney University Nepean Clinical SchoolKingswoodNew South WalesAustralia
| | | |
Collapse
|
6
|
Ozkaya Senuren C, Yaylaci S, Kayayurt K, Aldinc H, Gun C, Şimşek P, Tatli O, Turkmen S. Developing Cricothyroidotomy Skills Using a Biomaterial-Covered Model. Wilderness Environ Med 2020; 31:291-297. [PMID: 32855020 DOI: 10.1016/j.wem.2020.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 05/11/2020] [Accepted: 05/15/2020] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Cricothyroidotomy is an advanced and life-saving technique, but it is also a rare and a difficult procedure. The purpose of the present study was to produce a low-cost simulation model with realistic anatomic features to investigate its effectiveness in developing cricothyroidotomy skills. METHODS This study was performed at a university simulation center with 57 second-year student paramedics and a cricothyroidotomy simulation model. Total scores were assessed using a checklist. This consisted of 13 steps and was scored as misapplication/omission=0, correct performance and timing with hesitation=1, and correct performance and timing without hesitation=2. One of these steps, local anesthesia of the area if time is available, was not performed owing to time limitations. The highest possible score was 24. Data are presented as mean±SD with range, as appropriate. Normal distribution was evaluated using the Kolmogorov-Smirnov test, Student t test, and Mann-Whitney U test, and correlation analysis was used for statistical analysis. RESULTS Students completed the cricothyroidotomy procedure steps in 116±46 (55-238) s. At performance assessment, the score achieved was 12±5 (2-24). The highest total score of 24 was achieved by 3 students (5%). Total scores exhibited negative and significant correlation with procedure time (r=-0.403, P=0.002). CONCLUSIONS The model developed in this study is an inexpensive and effective method that can be used in cricothyroidotomy training for student paramedics. We think that repeating the cricothyroidotomy procedure on the model will increase success levels.
Collapse
Affiliation(s)
- Cigdem Ozkaya Senuren
- Department of First and Emergency Aid, Vocational School of Health Services, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey.
| | - Serpil Yaylaci
- Department of First and Emergency Aid, Vocational School of Health Services, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey; Department of Emergency Medicine, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Kamil Kayayurt
- Department of First and Emergency Aid, Vocational School of Health Services, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey; Department of Emergency Medicine, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Hasan Aldinc
- Department of First and Emergency Aid, Vocational School of Health Services, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey; Department of Emergency Medicine, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Cem Gun
- Department of First and Emergency Aid, Vocational School of Health Services, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey; Department of Emergency Medicine, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Perihan Şimşek
- Department of Nursing, Faculty of Health Sciences, Karadeniz Technical University, Trabzon, Turkey
| | - Ozgur Tatli
- Department of Emergency Medicine, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Suha Turkmen
- Department of First and Emergency Aid, Vocational School of Health Services, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey; Department of Emergency Medicine, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey; Hamad Medical Corporation, Emergency Department, Doha, Qatar
| |
Collapse
|
7
|
Andresen ÅEL, Kramer‐Johansen J, Kristiansen T. Percutaneous vs surgical emergency cricothyroidotomy: An experimental randomized crossover study on an animal-larynx model. Acta Anaesthesiol Scand 2019; 63:1306-1312. [PMID: 31287154 DOI: 10.1111/aas.13447] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 06/17/2019] [Accepted: 06/18/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Airway management is a paramount clinical skill for the anaesthesiologist. The Emergency Cricothyroidotomy (EC) constitutes the final step in difficult airway algorithms securing a patent airway via a front-of-neck access. The main distinction among available techniques is whether the procedure is surgical and scalpel-based or percutaneous and needle-based. METHODS In an experimental randomized crossover trial, using an animal larynx model, we compared two EC techniques; the Rapid Four Step Technique and the Melker Emergency Cricothyrotomy Kit®. We assessed time expenditure and success rates among 20 anaesthesiologists and related this to previous training, seniority and clinical experience with EC. RESULTS All participants achieved successful airway access with both methods. Average time to successful airway access for scalpel-based EC was 54 (±31) seconds and for percutaneous EC 89 (±38) seconds, with 35 (95% CI: 14-57) seconds time difference, P = .003. Doctors with recent (<12 months) EC training performed better compared to the non-training group (37 vs 61 seconds, P = .03 for scalpel-based EC, and 65 vs 99 seconds, P = .02 for percutaneous EC). We found no differences according to clinical seniority or previous real-life EC experience. CONCLUSIONS Our study demonstrated that anaesthesiologists achieved successful airway access on an animal experimental model with both EC methods within a reasonable time frame, but the scalpel-based EC is performed more promptly. Recent EC training affected the time expenditure positively, while seniority and clinical EC experience did not. EC procedures should be regularly trained for.
Collapse
Affiliation(s)
- Åke Erling L. Andresen
- Department of Research Norwegian Air Ambulance Foundation Oslo Norway
- Department of Anaesthesiology and Intensive Care Vestre Viken Hospital Trust Drammen Norway
| | - Jo Kramer‐Johansen
- Division of Prehospital Services, Institute of Clinical Medicine University of Oslo Oslo Norway
- Norwegian National Advisory Unit on Prehospital Emergency Medicine Oslo University Hospital Oslo Norway
| | - Thomas Kristiansen
- Department of Anaesthesiology, Division of Emergencies and Critical Care Oslo University Hospital, Rikshospitalet Oslo Norway
- Division of Emergencies and Critical Care Institute of Clinical Medicine, University of Oslo Oslo Norway
- Norwegian National Advisory Unit on Trauma, Division of Emergencies and Critical Care Oslo University Hospital Oslo Norway
| |
Collapse
|
8
|
Shetty K, Nayyar V, Stachowski E, Byth K. Training for Cricothyroidotomy. Anaesth Intensive Care 2019; 41:623-30. [DOI: 10.1177/0310057x1304100508] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- K. Shetty
- Intensive Care Unit, Westmead Hospital, Westmead, New South Wales, Australia
| | - V. Nayyar
- Intensive Care Unit, Westmead Hospital, Westmead, New South Wales, Australia
| | - E. Stachowski
- Intensive Care Unit, Westmead Hospital, Westmead, New South Wales, Australia
| | - K. Byth
- Intensive Care Unit, Westmead Hospital, Westmead, New South Wales, Australia
- University of Sydney, Sydney
| |
Collapse
|
9
|
Emergency Airway Management in a Simulation of Highly Contagious Isolated Patients: Both Isolation Strategy and Device Type Matter. Infect Control Hosp Epidemiol 2018; 39:145-151. [PMID: 29417920 DOI: 10.1017/ice.2017.287] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To compare 6 airway-management devices in 3 isolation scenarios regarding their effect on airway management: portable isolation unit (PIU), personal protective equipment (PPE), and standard protection measures METHODS In total, 30 anesthesiologists working in emergency medical services performed airway management on mannequins in 3 isolation settings using 6 different airway management devices (in random order): (1) standard Macintosh laryngoscope; (2) Airtraq SP-video-laryngoscope; (3) i-gel; (4) LMA-Fastrach; (5) Ambu fiberoptic-aScope; and (6) Melker cricothyrotomy-set. Each was assessed regarding time-to-ventilate (primary outcome) and rating of difficulty handling the device. RESULTS In 86% (standard protection) and 85% (PPE) of attempts, airway management was achieved in <60 seconds, irrespective of the device used. In the PIU setting, only 69% of attempts succeeded within this time frame (P<.05). Median time-to-ventilate was shorter for standard protection (23 seconds) and PPE (25 seconds) compared to the PIU (38 seconds; P<.001). In the PIU setting, the fiberscope took the longest (median, 170 seconds), while i-gel was the quickest (median, 13 seconds). The rating of difficulty (visual analogue scale [VAS], 0-100) differed significantly between the isolation scenarios: Airway management was most difficult with PIU (VAS, 76), followed by PPE (VAS, 35), and standard protection (VAS, 9) (P<.01). CONCLUSION Wearing PPE produced similar times-to-ventilate as standard protection among anesthesiologists, but it was subjectively rated more difficult. The portable isolation unit permitted acceptable times-to-ventilate when excluding fiberscope and cricothyrotomy. Supraglottic airway devices allowed the fastest airway management in all isolation scenarios, thus being highly recommendable if a portable isolation unit is used and emergency airway management becomes necessary. Infect Control Hosp Epidemiol 2018;39:145-151.
Collapse
|
10
|
Dorsam JM, Cornelius SR, McLean JB, Zarow GJ, Walchak AC, Conley SP, Roszko PJD. Randomized Comparative Assessment of Three Surgical Cricothyrotomy Devices on Airway Mannequins. PREHOSP EMERG CARE 2018; 23:411-419. [PMID: 30173584 DOI: 10.1080/10903127.2018.1518506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Airway obstruction is the second leading cause of preventable battlefield death, at least in part because surgical cricothyrotomy (SC) failure rates remain unacceptably high. Ideally, SC should be a rapid, simple, easily-learned, and reliably-performed procedure. Currently, 3 SC devices meet Tactical Combat Casualty Care (TCCC) standards: The Tactical CricKit® (TCK), Control-CricTM(CC), and Bougie-assisted Technique (BAT). However, no previous studies have compared these devices in application time, application success, user ratings, and user preference. METHODS United States Navy Corpsmen (N = 25) were provided 15 minutes of standardized instruction, followed by hands-on practice with each device on airway mannequins. Participants then performed SC with each of the 3 devices in a randomly assigned sequence. In this within-subjects design, application time, application success, participant ratings, and participant preference data were analyzed using repeated-measures ANOVA, regression, and non-parametric statistics at p < 0.05. RESULTS Application time for CC (M = 184 sec, 95% CI 144-225 sec) was significantly slower than for BAT (M = 135 sec, 95% CI 113-158 sec, p < 0.03) and TCK (M = 117 sec, 95% CI 93-142 sec, p < 0.005). Success was significantly greater for BAT (76%) than for TCK (40%, p < 0.02) and trended greater than CC (48%, p = 0.07). CC was rated significantly lower than TCK and BAT in ease of application, effectiveness, and reliability (each p < 0.01). User preference was significantly (p < 0.01) higher for TCK (58%) and BAT (42%) than for CC (0%). Improved CC blade design was the most common user suggestion. CONCLUSION While this study was limited by the use of mannequins in a laboratory environment, present results indicate that none of these devices was ideal for performing SC. Based on slow application times, low success rates, and user feedback, the Control-CricTM cannot be recommended until improvements are made to the blade design.
Collapse
|
11
|
March JA, Kiemeney MJ, De Guzman J, Ferguson JD. Retention of cricothyrotomy skills by paramedics using a wire guided technique. Am J Emerg Med 2018; 37:407-410. [PMID: 29891124 DOI: 10.1016/j.ajem.2018.05.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 05/25/2018] [Accepted: 05/29/2018] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Cricothyrotomy may be necessary for airway management when a patient's airway cannot be maintained through standard techniques such as oral airway placement, blind insertion airway device, or endotracheal intubation. Wire-guided cricothyrotomy is one of many techniques used to perform a cricothyrotomy. Although there is some controversy over which cricothyrotomy technique is superior, there is no published data regarding long term retention rates. The purpose of this study is to determine whether ground based paramedics can be taught and are able to retain the skills necessary to successfully perform a wire-guided cricothyrotomy. METHODS This retrospective study was performed in a suburban county with a population of 160,000 with 23,000 EMS calls per year. Participants were ground-based paramedics who were taught wire-guided cricothyrotomy as part of a standardized paramedic educational update program. After viewing an instructional video, the paramedics were shown each the steps of the procedure on a simulation model, using a low fidelity task trainer previously developed to train emergency medicine residents. Using a 16 step procedural checklist, participants were allowed open-ended practice using the task trainer. Critical steps in the checklist were marked in bold lettering indicating automatic failure. Each paramedic was then individually supervised performing a minimum of 5 successful simulations. Retention was assessed using the same 16 step checklist 6 to 12 weeks following the initial training. RESULTS A total of 55 paramedics completed both the initial training and reassessment during the time period studied. During the initial training phase 100% (55 of 55) of the paramedics were successful in performing all 16 steps of the wire-guided cricothyrotomy. During the retention phase, 87.3% (48 of 55) of paramedics retained the skills necessary to successfully perform the wire-guided cricothyrotomy. On the 16 step checklist, most steps were performed successfully by all the paramedics or missed by only 1 of the 55 paramedics. The step involving removal of the needle prior to advancing the airway device over the guide wire was missed by 34.5% (19 of 55) of the participants. This was not an automatic failure since most participants immediately self-corrected and completed the procedure successfully. CONCLUSION Paramedics can be taught and can retain the skills necessary to successfully perform a wire-guided cricothyrotomy on a simulator. Future research is necessary to determine if paramedics can successfully transfer these skills to real patients.
Collapse
Affiliation(s)
- J A March
- Department of Emergency Medicine, Division of EMS, East Carolina University Brody School of Medicine, Greenville, NC, United States.
| | - M J Kiemeney
- Department of Emergency Medicine, Division of EMS, East Carolina University Brody School of Medicine, Greenville, NC, United States
| | - J De Guzman
- Department of Emergency Medicine, Division of EMS, East Carolina University Brody School of Medicine, Greenville, NC, United States
| | - J D Ferguson
- Department of Emergency Medicine, Division of EMS, East Carolina University Brody School of Medicine, Greenville, NC, United States
| |
Collapse
|
12
|
Cricothyroidotomy In Situ Simulation Curriculum (CRIC Study): Training Residents for Rare Procedures. Simul Healthc 2018; 12:76-82. [PMID: 28704285 DOI: 10.1097/sih.0000000000000206] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Technical skill acquisition for rare procedures can be challenging given the few real-life training opportunities. In situ simulation (ISS), a training technique that takes place in the actual workplace, is a promising method to promote environmental fidelity for rare procedures. This study evaluated a simulation-based technical skill curriculum for cricothyroidotomy using deliberate practice, followed by an ISS evaluation session. METHODS Twenty emergency medicine residents participated in a two-part curriculum to improve cricothryoidotomy performance. A pretest established participant baseline technical skill. The training session consisted of two parts, didactic teaching followed by deliberate practice using a task-training manikin. A posttest consisted of an unannounced, high-fidelity ISS, during an emergency department shift. The primary outcome was the mean performance time between the pretest and posttest sessions. Skill performance was also evaluated using a checklist scale and global rating scale. RESULTS Cricothyroidotomy performance time improved significantly from pretest to posttest sessions (mean difference, 59 seconds; P < 0.0001). Both checklist and global rating scales improved significantly from the pretest to the posttest with a mean difference of 1.82 (P = 0.002) and 6.87 (P = 0.0025), respectively. Postcourse survey responses were favorable for both the overall curriculum experience and the unannounced ISS. CONCLUSIONS This pilot study demonstrated that unannounced ISS is feasible and can be used to effectively measure cricothyroidotomy performance among EM residents. After a two-part training session consisting of didactic learning and deliberate practice, improved cricothyroidotomy skill performance was observed during an unannounced ISS in the emergency department. The integration of ISS in cricothyroidotomy training represents a promising approach; however, further study is needed to establish its role.
Collapse
|
13
|
Petrosoniak A, Almeida R, Pozzobon LD, Hicks C, Fan M, White K, McGowan M, Trbovich P. Tracking workflow during high-stakes resuscitation: the application of a novel clinician movement tracing tool during in situ trauma simulation. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2018; 5:78-84. [PMID: 35519836 PMCID: PMC8936949 DOI: 10.1136/bmjstel-2017-000300] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/02/2018] [Indexed: 11/08/2022]
Abstract
Introduction Clinician movement and workflow analysis provides an opportunity to identify inefficiencies during trauma resuscitation care. Inefficient workflows may represent latent safety threats (LSTs), defined as unrecognised system-based elements that can negatively impact patients. In situ simulation (ISS) can be used to model resuscitation workflows without direct impact on patients. We report the pilot application of a novel, tracing tool to track clinician movement during high-fidelity ISS trauma sessions. Methods Twelve unannounced ISSs were conducted. An open source, Windows-based video overlay tracing tool was developed to generate a visual representation of participant movement during ISS. This tracing tool used a manual mouse tracking algorithm to produce point-by-point location information of a selected participant in a video. The tracing tool was applied to video recordings of clinicians performing a cricothyroidotomy during ISS trauma scenarios. A comparative workflow and movement analysis was completed, which included distance travelled and space utilisation. This data was visually represented with time-lapsed movement videos and heat maps. Results A fourfold difference in the relative distance travelled was observed between participants who performed a cricothyroidotomy during an ISS trauma resuscitation. Variation in each participant’s movement was attributable to three factors: (1) team role assignment and task allocation; (2) knowledge of clinical space: equipment location and path to equipment retrieval; and (3) equipment bundling. This tool facilitated LST identification related to cricothyroidotomy performance. Conclusion This novel tracing tool effectively generated a visual representation of participants’ workflows and quantified movement during ISS video review. An improved understanding of human movement during ISS trauma resuscitations provides a unique opportunity to augment simulation debriefing, conduct human factor analysis of system elements (eg, tools/technology, physical environment/layout) and foster change management towards efficient workflows.
Collapse
Affiliation(s)
- Andrew Petrosoniak
- Department of Emergency Medicine, St Michael’s Hospital, Toronto, Ontario, Canada
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rodrigo Almeida
- Information, Technology and System’s Engineering Institute, Universidade Federal de Itajubá, Itajuba, Minas Gerais, Brazil
| | | | - Christopher Hicks
- Department of Emergency Medicine, St Michael’s Hospital, Toronto, Ontario, Canada
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mark Fan
- Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
| | - Kari White
- Respiratory Therapy, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Melissa McGowan
- Department of Emergency Medicine, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Patricia Trbovich
- Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
14
|
Prophylactic percutaneous dilatational cricothyrotomy, prior to surgical tracheostomy: Case report☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1097/01819236-201712001-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
15
|
Emergency Cricothyrotomy Performed by Surgical Airway-naive Medical Personnel: A Randomized Crossover Study in Cadavers Comparing Three Commonly Used Techniques. Anesthesiology 2017; 125:295-303. [PMID: 27275669 DOI: 10.1097/aln.0000000000001196] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND When conventional approaches to obtain effective ventilation and return of effective spontaneous breathing fail, surgical airway is the last rescue option. Most physicians have a limited lifetime experience with cricothyrotomy, and it is unclear what method should be taught for this lifesaving procedure. The aim of this study is to compare the performance of medical personnel, naive to surgical airway techniques, in establishing an emergency surgical airway in cadavers using three commonly used cricothyrotomy techniques. METHODS Twenty medical students, without previous knowledge of surgical airway techniques, were randomly selected from their class. After training, they performed cricothyrotomy by three techniques (surgical, Melker, and QuickTrach II) in a random order on 60 cadavers with comparable biometrics. The time to complete the procedure, rate of success, and number of complications were recorded. A success was defined as the correct placement of the cannula within the trachea in 3 min. RESULTS The success rates were 95, 55, and 50% for surgical cricothyrotomy, QuickTrach, and Melker, respectively (P = 0.025). The majority of failures were due to cannula misplacement (15 of 20). In successful procedures, the mean procedure time was 94 ± 35 s in the surgical group, 77 ± 34 in the QuickTrach II group, and 149 ± 24 in the Melker group (P < 0.001). Few significant complications were found in successful procedures. No cadaver biometric parameters were correlated with success of the procedure. CONCLUSION Surgical airway-naive medical personnel establish emergency cricothyrotomy more efficiently and safely with the surgical procedure than with the other two commonly used techniques.
Collapse
|
16
|
Braun C, Kisser U, Huber A, Stelter K. Bystander cricothyroidotomy with household devices – A fresh cadaveric feasibility study. Resuscitation 2017; 110:37-41. [DOI: 10.1016/j.resuscitation.2016.10.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 09/18/2016] [Accepted: 10/09/2016] [Indexed: 11/17/2022]
|
17
|
Prophylactic percutaneous dilatational cricothyrotomy, prior to surgical tracheostomy: Case report. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rcae.2016.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
18
|
Medina-Ramírez S, Posada-Upegui JC, Hoyos-Fajardo LM, Avendaño-Quintero D. Realización de cricotiroidotomía percutánea por dilatación de manera profiláctica, previa a traqueostomía quirúrgica: reporte de un caso. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rca.2016.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
19
|
Akulian JA, Yarmus L, Feller-Kopman D. The role of cricothyrotomy, tracheostomy, and percutaneous tracheostomy in airway management. Anesthesiol Clin 2016; 33:357-67. [PMID: 25999008 DOI: 10.1016/j.anclin.2015.02.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cricothyrotomy, percutaneous dilation tracheostomy, and surgical tracheostomy are cost-effective and safe techniques employed in the management of critically ill patients requiring insertion of an artificial airway. These procedures have been well characterized and studied in the surgical, emergency medicine, and critical care literature. This article focuses on the role of each of these modalities in airway management, specifically comparing the data for each procedure in regard to procedural outcomes. The authors discuss the techniques available and the relevant background data regarding choice of each method and its integration into clinical practice.
Collapse
Affiliation(s)
- Jason A Akulian
- Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, 8007 Burnett Womack, CB 7219, Chapel Hill, NC 27599-7219, USA
| | - Lonny Yarmus
- Section of Interventional Pulmonology, Division of Pulmonary and Critical Care, Johns Hopkins Hospital, Johns Hopkins University, 1800 Orleans Street, Suite 7125, Baltimore, MD 21287, USA
| | - David Feller-Kopman
- Bronchoscopy and Interventional Pulmonology, Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins Hospital, Johns Hopkins University, Baltimore, MD 21287, USA.
| |
Collapse
|
20
|
Abstract
Pre-hospital care requires a broad skillset. One of the most challenging aspects of pre-hospital care is performing surgical procedures. The indications and evidence for performing pre-hospital surgical airway, thoracostomy, thoracotomy, caesarean section and amputation are discussed. Where evidence for the procedure is lacking from pre-hospital care, evidence from in-hospital experience is sought.
Collapse
|
21
|
King W, Teare J, Vandrevala T, Cartwright S, Mohammed KB, Patel B. Evaluation of a novel Surgicric® cricothyroidotomy device for emergency tracheal access in a porcine model. Anaesthesia 2015; 71:177-84. [PMID: 26572240 DOI: 10.1111/anae.13275] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2015] [Indexed: 12/21/2022]
Abstract
A can't intubate, can't ventilate scenario can result in morbidity and death. Although a rare occurrence (1:50 000 general anaesthetics), it is crucial that anaesthetists maintain the skills necessary to perform cricothyroidotomy, and are well-equipped with appropriate tools. We undertook a bench study comparing a new device, Surgicric(®) , with two established techniques; the Melker Emergency Cricothyroidotomy, and a surgical technique. Twenty-five anaesthetists performed simulated emergency cricothyroidotomy on a porcine model, with the primary outcome measure being insertion time. Secondary outcomes included success rate, tracheal trauma and ease of use. The surgical technique was fastest. The median (IQR [range]) was 81 (62-126 [37-300]) s, followed by the Melker 124 (100-217 [71-300]) s, and the Surgicric 127 (68-171 [43-300]), p = 0.003. The Surgicric device was the most traumatic, as evaluated by a blinded Ear, Nose and Throat surgeon. Subsequently, the authors contacted the device manufacturer, who has now modified the kit in the hope that its clinical application might be improved. Further studies are required to evaluate the revised model.
Collapse
Affiliation(s)
- W King
- Surrey Peri-operative Anaesthesia Critical Care Collaborative Research Group, Anaesthetic Department, Royal Surrey County Hospital, Guildford, Surrey, UK
| | - J Teare
- Surrey Peri-operative Anaesthesia Critical Care Collaborative Research Group, Anaesthetic Department, Royal Surrey County Hospital, Guildford, Surrey, UK
| | - T Vandrevala
- Research Design Service, Kingston Hospital, Surrey, UK
| | - S Cartwright
- ENT Department, Guy's and St Thomas' Hospitals, London, UK
| | - K B Mohammed
- Research and Development Department, The Royal Marsden Hospital, London, UK
| | - B Patel
- Surrey Peri-operative Anaesthesia Critical Care Collaborative Research Group, Anaesthetic Department, Royal Surrey County Hospital, Guildford, Surrey, UK
| |
Collapse
|
22
|
Uehara M, Kokuryo S, Sasaguri M, Tominaga K. Emergency Cricothyroidotomy for Difficult Airway Management After Asynchronous Bilateral Neck Dissections: A Case Report and Literature Review. J Oral Maxillofac Surg 2015; 73:2066.e1-7. [PMID: 26126919 DOI: 10.1016/j.joms.2015.06.152] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 06/06/2015] [Accepted: 06/07/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE This report describes a case that required emergency cricothyroidotomy for an upper airway obstruction owing to laryngeal edema after asynchronous bilateral neck dissections. PATIENT AND METHODS A 57-year-old man was diagnosed with multicentric squamous cell carcinoma of the tongue (T1 and 2N0M0), and partial glossectomy with primary closure was performed. Three months after surgery, secondary metastases in the right cervical lymph nodes were detected, and a right radical neck dissection was performed. Contrast-enhanced computed tomographic (CT) scan taken 2 weeks after the right neck dissection visualized a possible third metastasis in the left cervical lymph node. Four weeks after the right radical neck dissection, left supraomohyoid neck dissection was carried out. In this surgery, the left internal jugular vein (IJV) was preserved. Nine hours after surgery, severe swelling of the face and pharynx was recognized, resulting in a stoppage of respiration and then an emergency cricothyroidotomy. RESULTS The patient's life was saved without any encephalopathy or airway trouble. Contrast-enhanced CT scan taken the next day confirmed the preserved left IJV patency. CONCLUSION Oral and maxillofacial surgeons should be aware of the possibility of life-threatening laryngeal edema associated with bilateral neck dissections even if the unilateral IJV is preserved and should know the procedure for emergency cricothyroidotomy.
Collapse
Affiliation(s)
- Masataka Uehara
- Lecturer, Division of Maxillofacial Surgery, Department of Science of Physical Functions, Kyushu Dental University, Fukuoka, Japan.
| | - Shinya Kokuryo
- Lecturer, Division of Oral Medicine, Department of Science of Physical Functions, Kyushu Dental University, Fukuoka, Japan
| | - Masaaki Sasaguri
- Associate Professor, Division of Maxillofacial Surgery, Department of Science of Physical Functions, Kyushu Dental University, Fukuoka, Japan
| | - Kazuhiro Tominaga
- Professor and Chairman, Division of Maxillofacial Surgery, Department of Science of Physical Functions, Kyushu Dental University, Fukuoka, Japan
| |
Collapse
|
23
|
Combining transtracheal catheter oxygenation and needle-based Seldinger cricothyrotomy into a single, sequential procedure. Am J Emerg Med 2015; 33:708-12. [DOI: 10.1016/j.ajem.2015.02.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 02/27/2015] [Accepted: 02/28/2015] [Indexed: 11/23/2022] Open
|
24
|
Emergent Surgical Airway: Comparison of the Three-Step Method and Conventional Cricothyroidotomy Utilizing High-Fidelity Simulation. J Emerg Med 2014; 46:304-7. [DOI: 10.1016/j.jemermed.2013.08.065] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 06/15/2013] [Accepted: 08/15/2013] [Indexed: 11/16/2022]
|
25
|
Langvad S, Hyldmo PK, Nakstad AR, Vist GE, Sandberg M. Emergency cricothyrotomy--a systematic review. Scand J Trauma Resusc Emerg Med 2013; 21:43. [PMID: 23725520 PMCID: PMC3704966 DOI: 10.1186/1757-7241-21-43] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 05/26/2013] [Indexed: 01/28/2023] Open
Abstract
Background An emergency cricothyrotomy is the last-resort in most airway management protocols and is performed when it is not possible to intubate or ventilate a patient. This situation can rapidly prove fatal, making it important to identify the best method to establish a secure airway. We conducted a systematic review to identify whether there exists superiority between available commercial kits versus traditional surgical and needle techniques. Methods Medline, EMBASE and other databases were searched for pertinent studies. The inclusion criteria included manikin, animal and human studies and there were no restrictions regarding the professional background of the person performing the procedure. Results In total, 1,405 unique references were identified; 108 full text articles were retrieved; and 24 studies were included in the review. Studies comparing kits with one another or with various surgical and needle techniques were identified. The outcome measures included in this systematic review were success rate and time consumption. The investigators performing the studies had chosen unique combinations of starting and stopping points for time measurements, making comparisons between studies difficult and leading to many conflicting results. No single method was shown to be better than the others, but the size of the studies makes it impossible to draw firm conclusions. Conclusions The large majority of the studies were too small to demonstrate statistically significant differences, and the limited available evidence was of low or very low quality. That none of the techniques in these studies demonstrated better results than the others does not necessarily indicate that each is equally good, and these conclusions will likely change as new evidence becomes available.
Collapse
Affiliation(s)
- Sofie Langvad
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | | | | | | |
Collapse
|
26
|
Optimizing Emergent Surgical Cricothyrotomy for use in Austere Environments. Wilderness Environ Med 2013; 24:53-66. [DOI: 10.1016/j.wem.2012.07.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Revised: 06/23/2012] [Accepted: 07/03/2012] [Indexed: 11/23/2022]
|
27
|
Abstract
Children comprise approximately one-quarter of all visits to most emergency departments. Children are generally healthier than adults, yet there are similar priorities in assessment and management of pediatric patients. The initial approach to airway, breathing, and circulation still applies and is first and foremost in the evaluation of young infants and children. There are certain anatomic, physiologic, developmental, and social considerations that are unique to this population and must be taken into account during their evaluation and treatment. In this review, we present and discuss an evidence-based approach to high-yield procedures necessary for all emergency physicians taking care of children.
Collapse
Affiliation(s)
- Fernando Soto
- Pediatric Emergency Medicine Section, University of Puerto Rico School of Medicine, PO Box 29207, San Juan, PR 00929, USA.
| | | | | |
Collapse
|
28
|
Kanji H, Thirsk W, Dong S, Szava-Kovats M, Villa-Roel C, Singh M, Rowe BH. Emergency cricothyroidotomy: a randomized crossover trial comparing percutaneous techniques: classic needle first versus "incision first". Acad Emerg Med 2012; 19:E1061-7. [PMID: 22978733 DOI: 10.1111/j.1553-2712.2012.01436.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Emergency cricothyroidotomy is potentially lifesaving in patients with airway compromise who cannot be intubated or ventilated by conventional means. The literature remains divided on the best insertion technique, namely, the open/surgical and percutaneous methods. The two are not mutually exclusive, and the study hypothesis was that an "incision-first" modification (IF) may improve the traditional needle-first (NF) percutaneous approach. This study assessed the IF technique compared to the NF method. METHODS A randomized controlled crossover design with concealed allocation was completed for 180 simulated tracheal models. Attending and resident emergency physicians were enrolled. The primary outcome was time to successful cannulation; secondary outcomes included needle insertion(s), incision, and dilatation attempts. Finally, proportions of intratracheal insertion on the first attempt and subjective ease of insertion were compared. RESULTS The IF technique was significantly faster than the standard NF technique (median = 53 seconds, interquartile range [IQR] = 45.0 to 86.4 seconds vs. median = 90 seconds, IQR = 55.2 to 108.6 seconds; p < 0.001). The median number of needle insertions was significantly higher for the NF technique (p = 0.018); there was no significant difference in dilation or incision attempts. Intratracheal insertion on the first attempt was documented in 90 and 93% of the NF and IF techniques, respectively (p = 0.317). All the study participants found the IF hybrid approach easier. CONCLUSIONS The IF modification allows faster access, fewer complications, and more favorable clinician endorsement than the classic NF percutaneous technique in a validated model of cricothyroidotomy. We suggest therefore that the IF technique be considered as an improved method for insertion of an emergency cricothyroidotomy.
Collapse
Affiliation(s)
- Hussein Kanji
- Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | | | | | | | | | | |
Collapse
|
29
|
Helm M, Hossfeld B, Jost C, Lampl L, Böckers T. Emergency cricothyroidotomy performed by inexperienced clinicians--surgical technique versus indicator-guided puncture technique. Emerg Med J 2012; 30:646-9. [PMID: 22843552 PMCID: PMC3717590 DOI: 10.1136/emermed-2012-201493] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background To improve the ease and safety of cricothyroidotomy especially in the hand of the inexperienced, new instruments have been developed. In this study, we compared a new indicator-guided puncture technique (PCK) with standard surgical technique (ST) regarding success rate, performance time and complications. Methods Cricothyroidotomy in 30 human cadavers performed by 30 first year anaesthesia residents. The set chosen for use was randomised: PCK-technique (n=15) and ST (n=15). Success rates, insertion times and complications were compared. Traumatic lesions were anatomically confirmed after dissection. Results The ST-group had a higher success rate (100% vs 67%; p=0.04). There was no difference in time taken to complete the procedure (PCK 82 s. vs ST 95 s.; p=0.89). There was a higher complication rate in the PCK-group (67% vs 13%; p=0.04). Most frequent complication in the PCK-group was injury to the posterior tracheal wall (n=8), penetration to the oesophageal lumen (n=4) and injury to the thyroid and/or cricoid cartilage (n=5). In the ST-group in only 2 cases minor complications were observed (small vessel injury). Conclusions In this human cadaver study the PCK technique produced more major complications and more failures than the ST. In the hand of the inexperienced operator the standard surgical approach seems to be a safe procedure, which can successfully be performed within an adequate time. The PCK technique cannot be recommended for inexperienced operators.
Collapse
Affiliation(s)
- Matthias Helm
- Department of Anaesthesiology and Intensive Care Medicine-Section Emergency, Medicine/Federal Armed Forces Medical Centre, Ulm, Germany.
| | | | | | | | | |
Collapse
|
30
|
Hamaekers AE, Henderson JJ. Equipment and strategies for emergency tracheal access in the adult patient. Anaesthesia 2011; 66 Suppl 2:65-80. [DOI: 10.1111/j.1365-2044.2011.06936.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
31
|
Metterlein T, Frommer M, Ginzkey C, Becher J, Schuster F, Roewer N, Kranke P. A Randomized Trial Comparing Two Cuffed Emergency Cricothyrotomy Devices Using a Wire-Guided and a Catheter-Over-Needle Technique. J Emerg Med 2011; 41:326-32. [DOI: 10.1016/j.jemermed.2010.04.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2009] [Revised: 11/15/2009] [Accepted: 04/04/2010] [Indexed: 11/28/2022]
|
32
|
Combes X, Jabre P, Amathieu R, Abdi W, Luis D, Sebbah JL, Leroux B, Dhonneur G. [Cricothyrotomy in emergency context: assessment of a cannot intubate cannot ventilate scenario]. ACTA ACUST UNITED AC 2011; 30:113-6. [PMID: 21282035 DOI: 10.1016/j.annfar.2010.11.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2010] [Accepted: 11/19/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The aim of this study was to assess airway management by emergency physicians in case of a simulated situation where intubation and ventilation were both impossible. STUDY DESIGN Observational manikin study. METHODS A manikin (Airman®; Laerdal) allowing simulating difficult airway situations was used. The scenario assessed concerned a patient needing tracheal intubation for severe traumatic brain injury. The manikin was settled to make tracheal intubation under direct laryngoscopy impossible at the first attempt and to make facemask ventilation impossible after the second attempt. Manikin could initially be ventilated through the intubating laryngeal mask Airway (ILMA) but became impossible few seconds after its insertion. With impossible ventilation through the ILMA, arterial oxygen saturation decreased during 2 minutes before an hypoxic cardiac arrest occurred. Physicians could use classic laryngoscope with Macintosh blade, a Gum Elastic Bougie, an ILMA and a cricothyrotomy set. Adhesion to the national airway management algorithm was assessed. Time to cricothyroidotomy decision after ventilation through ILMA became impossible was measured. RESULTS Twenty-five emergency physicians were assessed. For 14 of them, national expert conference algorithm was perfectly followed. For ten physicians, cricothyroidotomy decision was taken after hypoxic cardiac arrest occurred. CONCLUSION Simulation with a manikin is useful to assess the adhesion rate to difficult intubation algorithms. Our study shows that the decision making process for cricothyrotomy is too often delayed as soon as ventilation became impossible and oxygenation compromized.
Collapse
Affiliation(s)
- X Combes
- Samu-Smur 94, département d'anesthésie-réanimation chirurgicale, hôpital Henri-Mondor, 51 avenue du Maréchal-de-Lattre-de-Tassigny, Créteil, France.
| | | | | | | | | | | | | | | |
Collapse
|
33
|
Metterlein T, Frommer M, Kwok P, Lyer S, Graf BM, Sinner B. Emergency cricothyrotomy in infants--evaluation of a novel device in an animal model. Paediatr Anaesth 2011; 21:104-9. [PMID: 21210882 DOI: 10.1111/j.1460-9592.2010.03497.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND According to different algorithms of airway management, emergency cricothyrotomy is the final step in managing an otherwise not accessible airway. As an alternative to an open surgical procedure, minimally invasive approaches exist. Quicktrach baby™ is a commercially available set for a minimal invasive cricothyrotomy in infants. The set consists of a plastic cannula over a metal needle for direct placement in the trachea. So far, this device has not been evaluated for its intended use. OBJECTIVES We hypothesize that Quicktrach baby™ allows the establishment of an emergency airway. The aim was to prove that the device is easy to handle and the cricothyrotomy fast to perform. METHODS After approval of the local ethics committee, the study was performed on the cadavers of 10 adult rabbits. Cricothyrotomy was performed with Quicktrach baby™. Successful placement, performance time, and complication rate were documented. Possible ventilation with a breathing bag was evaluated. Data are reported as mean and interquartile range. RESULTS Successful placement of Quicktrach baby™ was possible in all attempts. The placement took 31 [23-43] s. In two cases, a fracture of the cricoid's cartilage was seen. In one animal, damage to the posterior wall mucosa was observed. In all cases, sufficient ventilation was possible. CONCLUSIONS Quicktrach™ baby proved to be a reliable technique. In the animal model, it is easy and fast to perform. Only a few minor complications occurred. Sufficient ventilation was possible in all attempts.
Collapse
Affiliation(s)
- T Metterlein
- Department of Anaesthesiology, University Hospital Regensburg, Regensburg, Germany.
| | | | | | | | | | | |
Collapse
|
34
|
Helm M, Hossfeld B, Jost C, Schwartz A, Lampl L, Bernhard M. Chirurgische Atemwegssicherung in der präklinischen Notfallmedizin. Notf Rett Med 2011. [DOI: 10.1007/s10049-010-1357-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
35
|
Murphy C, Rooney SJ, Maharaj CH, Laffey JG, Harte BH. Comparison of three cuffed emergency percutaneous cricothyroidotomy devices to conventional surgical cricothyroidotomy in a porcine model. Br J Anaesth 2011; 106:57-64. [PMID: 21037267 DOI: 10.1093/bja/aeq294] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Emergency cricothyroidotomy is a potentially life-saving procedure in the 'cannot intubate cannot ventilate (CICV)' scenario. Although surgical cricothyroidotomy remains the technique recommended in many 'CICV' algorithms, the insertion of a tracheostomy as a cannula over a trocar, or using the Seldinger method, may have advantages as they are more familiar to the anaesthetist. We compared the utility of three cuffed cricothyroidotomy devices: cuffed Melker®, Quicktrach 2®, and PCK® devices, with surgical cricothyroidotomy. METHODS After ethical committee approval and written informed consent, 20 anaesthetists performed cricothyroidotomy with all four devices in random order, in a pig larynx and trachea model covered in cured pelt. The primary endpoints were the rate of successful placement of the cricothyroidotomy device into the trachea and the duration of the insertion attempt. RESULTS The Melker® and Quicktrach 2® devices possessed advantages over the surgical approach, in contrast to the PCK® device, which performed less well. All 20 participants inserted the Melker®, with 19 being successful using the surgical approach and the Quicktrach 2®, whereas only 12 successfully inserted the PCK® device (PCK® vs surgical, P=0.02). The Quicktrach 2® had the fastest insertion times and caused least trauma to the posterior tracheal wall. The Melker® was rated highest by the participants and was the only device rated higher than the surgical technique. CONCLUSIONS The Melker® and Quicktrach 2® devices appear to hold particular promise as alternatives to surgical cricothyroidotomy. Further studies, in more clinically relevant models, are required to confirm these initial positive findings.
Collapse
Affiliation(s)
- C Murphy
- Department of Anaesthesia, Galway University Hospitals, Galway, Ireland
| | | | | | | | | |
Collapse
|
36
|
Latif R, Chhabra N, Ziegler C, Turan A, Carter MB. Teaching the surgical airway using fresh cadavers and confirming placement nonsurgically. J Clin Anesth 2010; 22:598-602. [DOI: 10.1016/j.jclinane.2010.05.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2009] [Revised: 03/30/2010] [Accepted: 05/11/2010] [Indexed: 10/18/2022]
|
37
|
Abstract
There are few conditions in emergency medicine as potentially challenging and high-risk as the difficult or failed airway. The emergency physician must be able to anticipate the difficult or failed airway, recognize associated physiologic deficits, and plan accordingly. Preparation, pretreatment strategies, and selection of alternative airway devices may mitigate the potential morbidity and management failure associated with the high-risk airway. There are a myriad of airway devices new to emergency medicine, which can increase the chance of successful airway management and rescue. Understanding why the airway is potentially difficult and assessing whether oxygenation can be maintained can guide the clinician's strategy and technique for successful management of the high-risk airway.
Collapse
Affiliation(s)
- Robert J Vissers
- Emergency Department, Legacy Emanuel Hospital, 2801 North Gantenbein Avenue, Portland, OR 97227, USA.
| | | |
Collapse
|
38
|
Mariappa V, Stachowski E, Balik M, Clark P, Nayyar V. Cricothyroidotomy: Comparison of three Different Techniques on a Porcine Airway. Anaesth Intensive Care 2009; 37:961-7. [DOI: 10.1177/0310057x0903700602] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We compared three different cricothyroidotomy techniques on a cadaveric porcine airway model to determine the most rapid, successful and safe method in emergency situations. In this observational comparative bench-test, surgical or scalpel cricothyroidotomy (ST), Cook Melker Cricothyrotomy Kit (CM) and Portex Cricothyroidotomy Kit (PCK) were evaluated. After a familiarisation program, four operators performed five procedures using each of the techniques. A dissected pig airway was housed in an airway training manikin. Time to successful completion of the procedure, complications and anatomical variations in the pig larynx were recorded. A patent airway was established in 20 of 20 (100%) attempts with CM technique, 11 of 20 (55%) with ST and six of 20 (30%) with PCK technique. The CM technique was associated with a higher success rate (P <0.001). There was no significant difference (P=0.4) in the median time (interquartile range) taken to achieve a patent airway; CM 50 seconds (40 to 57), ST 47 seconds (41 to 55) and PCK 63 seconds (41 to 150). There was a higher rate of posterior tracheal wall injury with the PCK technique (n=11) and ST technique (n=5). No complications were observed with CM technique. There were no significant anatomical variations in the pig larynxes. We conclude that the CM technique is safe, rapid and has a significantly higher success rate in achieving an artificial airway in this airway model. Overall, all the participants in our study preferred to use this kit in an emergency situation.
Collapse
Affiliation(s)
- V. Mariappa
- Intensive Care Unit, Westmead Hospital, Sydney, New South Wales, Australia
- Staff Specialist. Intensive Care Unit, Toowoomba Hospital, Toowoomba, Queensland
| | - E. Stachowski
- Intensive Care Unit, Westmead Hospital, Sydney, New South Wales, Australia
- Director, Intensive Care Unit
| | - M. Balik
- Intensive Care Unit, Westmead Hospital, Sydney, New South Wales, Australia
- Head of Intensive Care, General Teaching Hospital, Prague, Czech Republic
| | - P. Clark
- Intensive Care Unit, Westmead Hospital, Sydney, New South Wales, Australia
| | - V. Nayyar
- Intensive Care Unit, Westmead Hospital, Sydney, New South Wales, Australia
- Senior Staff Specialist, Intensive Care Unit
| |
Collapse
|
39
|
Keane MF, Brinsfield KH, Dyer KS, Roy S, White D. A LABORATORYCOMPARISON OFEMERGENCYPERCUTANEOUS ANDSURGICALCRICOTHYROTOMY BYPREHOSPITALPERSONNEL. PREHOSP EMERG CARE 2009. [DOI: 10.1080/312704001194] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
40
|
Heard AMB, Green RJ, Eakins P. The formulation and introduction of a ‘can't intubate, can't ventilate’ algorithm into clinical practice. Anaesthesia 2009; 64:601-8. [DOI: 10.1111/j.1365-2044.2009.05888.x] [Citation(s) in RCA: 133] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
41
|
Friedman Z, You-Ten KE, Bould MD, Naik V. Teaching Lifesaving Procedures: The Impact of Model Fidelity on Acquisition and Transfer of Cricothyrotomy Skills to Performance on Cadavers. Anesth Analg 2009. [DOI: 10.1213/ane.0b013e3181a1f8b3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
42
|
Schober P, Hegemann MC, Schwarte LA, Loer SA, Noetges P. Emergency cricothyrotomy—A comparative study of different techniques in human cadavers. Resuscitation 2009; 80:204-9. [DOI: 10.1016/j.resuscitation.2008.10.023] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2008] [Revised: 09/18/2008] [Accepted: 10/03/2008] [Indexed: 10/21/2022]
|
43
|
Abstract
Airway management in the emergency department is a critical skill that must be mastered by emergency physicians. When rapid-sequence induction with oral-tracheal intubation performed by way of direct laryngoscopy is difficult or impossible due to a variety of circumstances, an alternative method or device must be used for a rescue airway. Retrograde intubation requires little equipment and has few contraindications. This technique is easy to learn and has a high level of skill retention. Familiarity with this technique is a valuable addition to the airway-management armamentarium of emergency physicians caring for ill or injured patients. Variations of the technique have been described, and their use depends on the individual circumstances.
Collapse
Affiliation(s)
- David Burbulys
- David Geffen School of Medicine at UCLA, Department of Emergency Medicine, Harbor-UCLA Medical Center, 1000 West Carson Street, Box 21, Torrance, CA 90504, USA.
| | | |
Collapse
|
44
|
Archan S, Gumpert R, Kügler B, Seibert FJ, Prause G. Cricothyroidotomy on the scene in a patient with severe facial trauma and difficult neck anatomy. Am J Emerg Med 2009; 27:133.e1-133.e4. [DOI: 10.1016/j.ajem.2008.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Revised: 05/01/2008] [Accepted: 05/02/2008] [Indexed: 10/21/2022] Open
|
45
|
Friedman Z, You-Ten KE, Bould MD, Naik V. Teaching lifesaving procedures: the impact of model fidelity on acquisition and transfer of cricothyrotomy skills to performance on cadavers. Anesth Analg 2008; 107:1663-9. [PMID: 18931230 DOI: 10.1213/ane.0b013e3181841efe] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND A decline in emergency surgical airway procedures in recent years has resulted in a decreased exposure to cricothyrotomy. Consequently, residents have very little experience or confidence in performing this intervention. In this study, we compared cricothyrotomy skills acquired on a simple inexpensive model to those learned on a high fidelity simulator using valid evaluation instruments and testing on cadavers. METHODS First and second year anesthesiology residents were recruited. All subjects performed a videotaped pretest cricothyrotomy on cadavers. Subjects were randomized into two groups: The high fidelity group (n = 11) performed two cricothyrotomies on a full-scale simulator with an anatomically accurate larynx. The low fidelity group (n = 11) performed two cricothyrotomies on a low fidelity model constructed from corrugated tubing. Within 2 wk all subjects performed a posttest. Two blinded examiners graded and timed the performances using a checklist and a global rating scale. RESULTS There was no significant difference in the change from pretest to posttest performance between the model groups as evaluated by all three measures (all: P = NS). Training on both models significantly improved performance on all measures (all: P < 0.001). Inter-rater reliability was strong (checklist: r = 0.90; global rating scale: r = 0.89). CONCLUSIONS Our study shows that a simple inexpensive model achieved the same effect on objectively rated skill acquisition as did an expensive simulator. The skills acquired on both models transferred effectively to cadavers. Training for this life-saving skill does not need to be limited by simulator accessibility or cost.
Collapse
Affiliation(s)
- Zeev Friedman
- Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, 600 University Ave., Toronto M5G1X5, ON, Canada.
| | | | | | | |
Collapse
|
46
|
Dimitriadis JC, Paoloni R. Emergency cricothyroidotomy: a randomised crossover study of four methods. Anaesthesia 2008; 63:1204-8. [DOI: 10.1111/j.1365-2044.2008.05631.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
47
|
Wang EE, Quinones J, Fitch MT, Dooley-Hash S, Griswold-Theodorson S, Medzon R, Korley F, Laack T, Robinett A, Clay L. Developing technical expertise in emergency medicine--the role of simulation in procedural skill acquisition. Acad Emerg Med 2008; 15:1046-57. [PMID: 18785939 DOI: 10.1111/j.1553-2712.2008.00218.x] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Developing technical expertise in medical procedures is an integral component of emergency medicine (EM) practice and training. This article is the work of an expert panel composed of members from the Society for Academic Emergency Medicine (SAEM) Interest Group, the SAEM Technology in Medical Education Committee, and opinions derived from the May 2008 Academic Emergency Medicine Consensus Conference, "The Science of Simulation in Healthcare." The writing group reviewed the simulation literature on procedures germane to EM training, virtual reality training, and instructional learning theory as it pertains to skill acquisition and procedural skills decay. The authors discuss the role of simulation in teaching technical expertise, identify training conditions that lead to effective learning, and provide recommendations for future foci of research.
Collapse
Affiliation(s)
- Ernest E Wang
- Division of Emergency Medicine, Evanston Northwestern Healthcare, Evanston, IL, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
|
49
|
|
50
|
Mouadeb DA, Rees CJ, Belafsky PC. Utilization of the LifeStat Emergency Airway Device. Ann Otol Rhinol Laryngol 2008; 117:1-4. [DOI: 10.1177/000348940811700101] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: Management of the airway in an emergency may be a harrowing experience. The equipment necessary to perform this procedure is often inaccessible. The LifeStat emergency airway is a portable device approved by the US Food and Drug Administration in 1997 for emergency cricothyrotomy. It is small enough to secure to a keychain, thus allowing instantaneous access at all times. We present a retrospective case series to report the experience of clinicians who have used the LifeStat device. Methods: A survey instrument was sent to a convenience sample of health-care professionals who purchased the LifeStat emergency airway. The survey queried device use, user demographics, and the success, ease, complications, and location of use. Results: One thousand surveys were distributed, and 100 individuals responded. Fifteen percent (15 of 100) reported use of the device on 17 occasions. The LifeStat was used successfully in all 17 cases. Eighty-two percent (14 of 17) of emergency use was in hospitals. In all cases the device was positioned successfully on the first attempt. No complications were reported. Conclusions: The LifeStat device provides a relatively safe and effective means of performing emergency cricothyrotomy. The majority of emergency situations in which the device was deployed occurred in hospital settings.
Collapse
|