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Observational Study
. 2024 Jan 31;24(1):44.
doi: 10.1186/s12871-024-02423-x.

Difficult airway simulation-based training for anaesthesiologists: efficacy and skills retention within six months

Kateryna Bielka  1 , Iurii Kuchyn  2 , Hanna Fomina  2 , Olena Khomenko  2 , Iryna Kyselova  2   3 , Michael Frank  2
Affiliations
Observational Study

Difficult airway simulation-based training for anaesthesiologists: efficacy and skills retention within six months

Kateryna Bielka et al. BMC Anesthesiol. .

Abstract

Background: The aim of this study was to evaluate how anaesthesiologists manage a "cannot intubate, can ventilate" (CI) and "cannot intubate, cannot ventilate" (CICV) scenarios, and how following simulation training will affect their guideline adherence, skills and decision-making immediately after training and 6 months later.

Methods: A prospective controlled study was conducted from July to December 2022. Anaesthesiologists who applied for the continuous medical education course "Difficult Airway Management" were involved in the study. Each volunteer participated in two simulation scenarios (CI, CICV) with structural debriefing after each scenario. After the first simulation round, volunteers were trained in difficult airway management according to DAS guidelines, using the same equipment as during the simulation. The participants repeated the simulation scenarios the day after the training and six months later. The primary and secondary endpoints were compared between three rounds: initial simulation (Group 1), immediately after training (Group 2), and six months after training (Group 3).

Results: A total of 24 anaesthesiologists consented to participate in the study and completed the initial survey form. During the first session, 83.3% of participants had at least one major deviation from the DAS protocol. During the first CICV scenario, 79% of participants made at least one deviation from the DAS protocol. The second time after simulation training, significantly better results were achieved: the number of anaesthesiologists, who attempted more than 3 laryngoscopies decreased (OR = 7 [1.8-26.8], p = 0.006 right after training and OR = 3.9 [1.06-14.4], p = 0.035 6 month later); the number, who skipped the supralaryngeal device attempt, call for help and failure to initiate surgical airway also decreased. Simulation training also significantly decreases the time to call for help, cricothyroidotomy initiation time, and mean desaturation time and increases the odds ratio of successful cricothyroidotomy (OR 0.02 [0.003-0.14], p < 0.0001 right after training and OR = OR 0.02 [0.003-0.16] 6 months after training).

Conclusions: Anaesthesiologists usually display major deviations from DAS guidelines while managing CI and CICV scenarios. Simulation training improves their guideline adherence, skills, and decision-making when repeating the simulation immediately after training and 6 months later.

Study registration: NCT05913492, clinicaltrials.gov, 22/06/2023.

Keywords: Difficult airways; Intubation; Simulation.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Significant deviations from the DAS protocol during the first scenario, n of cases
Fig. 2
Fig. 2
Significant deviations from the DAS protocol in the second scenario, n of cases
See this image and copyright information in PMC

Comment in

References

    1. Nagaro T, Yorozuya T, Sotani M, et al. Survey of patients whose lungs could not be ventilated and whose trachea could not be intubated in university hospitals in Japan. J Anesth. 2003;17(4):232–40. doi: 10.1007/s00540-003-0187-3. - DOI - PubMed
    1. Sakles JC, Laurin EG, Rantapaa AA, Panacek EA. Airway management in the emergency department: a one-year study of 610 tracheal intubations. Ann Emerg Med. 1998;31(3):325–32. doi: 10.1016/s0196-0644(98)70342-7. - DOI - PubMed
    1. Bielka K, Kuchyn IY, Frank M, et al. Causes and consequences of anesthetic emergencies in Ukraine. Pain Anaesth & int care. 2022;2(99):26–32. doi: 10.25284/2519-2078.2(99).2022.265836. - DOI
    1. Frerk C, Mitchell VS, McNarry AF, et al. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaesth. 2015;115(6):827–48. doi: 10.1093/bja/aev371. - DOI - PMC - PubMed
    1. Nielsen RP, Nikolajsen L, Paltved C, Aagaard R. Effect of simulation-based team training in airway management: a systematic review. Anaesthesia. 2021;76(10):1404–15. doi: 10.1111/anae.15375. - DOI - PubMed

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