A mixed-methods pilot study to evaluate a collaborative anaesthetic and surgical training package for emergency surgical cricothyroidotomy

Anaesthesia and Intensive Care

Volumn 47, Issue 4, 2019, Pages 357-367

  Berwick, Richard J ^a   Gauntlett, William ^b   Silverio, Sergio A ^c   Wallace, Hilary ^a   Mercer, Simon ^a   Brown, Jeremy M ^d   Sandars, John E ^d   Morton, Ben ^a,e   Groom, Peter ^a  

^a ROYAL LIVERPOOL AND BROADGREEN UNIVERSITY HOSPITALS NHS TRUST   (United Kingdom)

^b ALDER HEY CHILDREN S HOSPITAL   (United Kingdom)

^c UNIVERSITY COLLEGE LONDON   (United Kingdom)

^d EDGE HILL UNIVERSITY   (United Kingdom)

^e LIVERPOOL SCHOOL OF TROPICAL MEDICINE   (United Kingdom)

Author keywords

Airway obstruction; high fidelity simulation training; surgical training; tracheostomy

Indexed keywords

ANESTHESIA; ANXIETY; ARTICLE; EMERGENCY SURGERY; HIGH FIDELITY SIMULATION TRAINING; HUMAN; INCISION; PANIC; PILOT STUDY; QUALITATIVE ANALYSIS; QUANTITATIVE ANALYSIS; SELF CONCEPT; SEMI STRUCTURED INTERVIEW; SKILL; SURGICAL TRAINING; THEORY; TRACHEOTOMY; AIRWAY OBSTRUCTION; ANESTHESIOLOGY; CRICOID CARTILAGE; EDUCATION; GENERAL SURGERY; TRACHEOSTOMY;

ANESTHETIC AGENT;

AIRWAY OBSTRUCTION; ANESTHESIOLOGY; ANESTHETICS; CRICOID CARTILAGE; EDUCATIONAL MEASUREMENT; GENERAL SURGERY; HUMANS; PILOT PROJECTS; TRACHEOSTOMY;

EID: 85071097671     PISSN: 0310057X     EISSN: 14480271     Source Type: Journal    
DOI: 10.1177/0310057X19861978     Document Type: Article

References (42)

1. Frerk C, Mitchell VS, McNarry AF,. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaesth 2015; 115: 827–848.
2. Australian and New Zealand College of Anaesthetists. Guidelines for the management of evolving airway obstruction: transition to the can’t intubate can’t oxygenate airway emergency. Available at: www.anzca.edu.au/documents/ps61bp-2017.pdf (accessed 9 July 2019).
3. American Society of Anesthesiologists. Practice guidelines for management of the difficult airway. Anesthesiology 2003; 118: 251–270.
4. Piepho T, Cavus E, Noppens R,. S1 guidelines on airway management. Anaesthesist 2015; 64: 27–40.
5. Law JA, Broemling N, Cooper RM,. The difficult airway with recommendations for management – Part 1 – Difficult tracheal intubation encountered in an unconscious/induced patient. Can J Anaesth 2013; 60: 1089–1118.
6. Cook TM, Woodall N, Frerk C, on behalf of the Fourth National Audit Project. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia. Br J Anaesth 2011; 106: 617–631.
7. Pracy JP, Brennan L, Cook TM,. Surgical intervention during a can’t intubate can’t oxygenate (CICO) event: emergency front-of-neck airway (FONA)? Br J Anaesth 2016; 117: 426–428.
8. Lockey D, Crewdson K, Weaver A,. Observational study of the success rates of intubation and failed intubation airway rescue techniques in 7256 attempted intubations of trauma patients by pre-hospital physicians. Br J Anaesth 2014; 113: 220–225.
9. Hubble MW, Wilfong DA, Brown LH,. A meta-analysis of prehospital airway control techniques part II: alternative airway devices and cricothyrotomy success rates. Prehosp Emerg Care 2010; 14: 515–530.
10. Timmermann A, Chrimes N, Hagberg CA., Need to consider human factors when determining first-line technique for emergency front-of-neck access. Br J Anaesth 2016; 117: 5–7.
11. Greenland KB, Acott C, Segal R,. Emergency surgical airway in life-threatening acute airway emergencies – why are we so reluctant to do it? Anaesth Intensive Care 2011; 39: 578–584.
12. Kennedy CC, Cannon EK, Warner DO,. Advanced airway management simulation training in medical education: a systematic review and meta-analysis. Crit Care Med 2014; 42: 169–178.
13. Lorello GR, Cook DA, Johnson RL,. Simulation-based training in anaesthesiology: a systematic review and meta-analysis. Br J Anaesth 2014; 112: 231–245.
14. Chrimes N., The Vortex: a universal ‘high-acuity implementation tool’ for emergency airway management. Br J Anaesth 2016; 117: i20–i27.
15. Craig P, Dieppe P, Macintyre S, Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ 2008; 337: a1655.
16. Hoffmann TC, Glasziou PP, Boutron I,. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ 2014; 348: g1687.
17. Bandura A., Guide for constructing self-efficacy scales. In: Pajares F, Urdan T, (eds) Self-efficacy beliefs of adolescents. Charlotte, NC: Information Age Publishing, 2006.
18. Ritchie J, Lewis J, (eds). Qualitative research practice: a guide for social science students and researchers. London: SAGE, 2003.
19. Turner CW, Lewis JR, Nielsen J., Determining usability test sample size. In Karwowski W, (ed.) International encyclopedia of ergonomics and human factors. Boca Raton, FL: CRC Press, 2006, pp.3084–3088.
20. Baker S, Edwards R., How many qualitative interviews is enough? Discussion Paper, National Centre for Research Methods, 2012.
21. Vasileiou K, Barnett J, Thorpe S,. Characterising and justifying sample size sufficiency in interview-based studies: systematic analysis of qualitative health research over a 15-year period. BMC Med Res Methodol 2018; 18: 148.
22. Levitan RM., Airway cam – videos, www.airwaycam.com/learning/ (assessed 10 August 2018).
23. Kundra P, Mishra SK, Ramesh A., Ultrasound of the airway. Indian J Anaesth 2011; 55: 456–462.
24. Wilkinson J, (2017) Available at: As easy as 1-2-3/1, www.criticalcarenorthampton.com/2017/01/17/as-easy-as-1-2-3-4-foamed-foamcc-difficultairway/ (accessed 19 June 2018).
25. Weingart S, (2015) EMCrit Wee – mind blowing cricothyrotomy video/1. Available at: www.emcrit.org/wee/real-surgical-airway/ (accessed 19 June 2018).
26. Groom P, Murray B, (2016) Surgical cricothyroidotomy – patient position and equipment/1. Available at: www.youtu.be/UFPYrb7aFoQ (accessed 19 June 2018).
27. Groom P, Murray B, (2016) Surgical cricothyroidotomy – can’t palpate procedure/1. Available at: www.youtu.be/W_oBgkDtG8g (accessed 19 June 2018).
28. Groom P, Murray B, (2016). Available at: Surgical cricothyroidotomy – can palpate procedure/1, www.youtu.be/yZabamSBX_E (accessed 19 June 2018).
29. Berwick RJ, Mercer SJ, Groom P., Evaluating the fidelity of a novel part-task trainer for emergency front of neck access training. BMJ Simul Technol Enhanced Learn 2018; 4: 101–102.
30. Stacey M., Practice under pressure: what neurology can learn from anaesthesia. Pract Neurol 2017; 17: 439–443.
31. Driskell JE, Copper C, Moran A., Does mental practice enhance performance? J Appl Psychol 1994; 79: 481–492.
32. Immenroth M, Bürger T, Brenner J,. Mental training in surgical education: a randomized controlled trial. Ann Surg 2007; 245: 385–391.
33. Higgs A, McGrath BA, Goddard C,. Guidelines for the management of tracheal intubation in critically ill adults. Br J Anaesth 2018; 120: 323–352.
34. Eraut M., Non‐formal learning and tacit knowledge in professional work. Br J Educ Psychol 2000; 70: 113–136.
35. Myatra SN, Kalkundre RS, Divatia JV., Optimizing education in difficult airway management: meeting the challenge. Curr Opin Anaesthesiol 2017; 30: 748–754.
36. Sury M, Palmer JH, Cook TM,. The state of UK anaesthesia: a survey of National Health Service activity in 2013. Br J Anaesth 2014; 113: 575–584.
37. ANZCA Airway Management Working Group (2014) Transition from supraglottic to infraglottic rescue in the ‘can’t intubate can’t oxygenate’ (CICO) scenario. Available at: www.anzca.edu.au/documents/report-from-the-anzca-airway-management-working-gr.pdf (accessed 22 February 2019).
38. Byrne A., What is simulation for? Anaesthesia 2012; 67: 219–225.
39. McCrossin KE, White HT, Sane S., 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. Anaesth Intensive Care 2014; 42: 207–212.
40. Borges BCR, Boet S, Siu LW,. Incomplete adherence to the ASA difficult airway algorithm is unchanged after a high-fidelity simulation session. Can J Anaesth 2010; 57: 644–649.
41. Wong DT, Prabhu AJ, Coloma M,. What is the minimum training required for successful cricothyroidotomy?: a study in mannequins. Anesthesiology 2003; 98: 349–353.
42. Warnakulasuriya SR, Harvey R, McNarry A., Translation of national guidelines into local practice. Clin Teach. Epub ahead of print 8 January 2019. DOI: 10.1111/tct.12995.