A Survey of Graduating Emergency Medicine Residents' Experience with Cricothyrotomy

Abstract

Introduction:The Emergency Medicine (EM) Residency Review Committee stipulates that residents perform 3 cricothyrotomies in training but does not distinguish between those done on patients or via other training methods. This study was designed to determine how many cricothyrotomies residents have performed on living patients, the breadth and prevalence of alternative methods of instruction, and residents’ degree of comfort with performing the procedure unassisted.Methods:We utilized a web-based tool to survey EM residents nearing graduation and gathered data regarding the number of cricothyrotomies performed on living and deceased patients, animals, and models/simulators. Residents indicating experience with the procedure were asked additional questions as to the indication, supervision, and outcome of their most recent cricothyrotomy. We also collected data regarding experience with rescue airway devices, observation of cricothyrotomy, and comfort (“0–10” scale with “10” representing complete confidence) regarding the procedure.Results:Of 296 residents surveyed, 22.0% performed a cricothyrotomy on a living patient, and 51.6% had witnessed at least one performed. Those who completed a single cricothyrotomy reported a significantly greater level of confidence, 6.3 (95% confidence interval [CI] 5.7–7.0), than those who did none, 4.4 (95% CI 4.1–4.7), p<<0.001. Most respondents, 68.1%, had used the recently deceased to practice the technique, and those who had done so more than once reported higher confidence, 5.5 (95% 5.1–5.9), than those who had never done so, 4.1 (95% CI 3.7–4.5), p<<0.001. Residents who practiced cricothyrotomy on both simulators and the recently deceased expressed more confidence, 5.4 (95% CI 5.0–5.8), than those who used only simulators, 4.0 (95% CI 3.6–4.5), p<<0.001. Neither utilization of models, simulators, or animals, nor observance of others’ performance of the procedure independently affected reported confidence among residents.Conclusion:While prevalence of cricothyrotomy and reported comfort with the procedure remain low, performing the procedure on living or deceased patients increased residents’ confidence in undertaking an unassisted cricothyrotomy upon graduation in the population surveyed. There is evidence to show that multiple methods of instruction may yield the highest benefit, but further study is needed.

Evaluation of an Innovative Bleeding Cricothyrotomy Model

“…It is important to note that although additional training improved scores, residents did not feel highly comfortable in performing a cricothyrotomy. This is consistent with previous research demonstrating that the average comfort of graduating residents is at 4.8 on a 10-point scale despite the majority of residents undergoing training on a variety of models [ 4 ]. Given the rarity of this procedure, it is unrealistic to expect clinical experience to serve as the sole training method for competence.…”

“…As a result of the wide array of available airway devices, the need for a surgical airway is decreasing. Many graduating EM residents will have never performed a cricothyrotomy in clinical practice [ 4 , 9 ]. The development of a trainer that can realistically simulate the procedure is necessary to train competent EM physicians [ 5 ].…”

“…With a prevalence noted to be 0.45% of the emergency department's airway management procedures, cricothyrotomy is a high-risk, low-frequency procedure [ 2 - 3 ]. Most emergency physicians will graduate from residency without having performed a cricothyrotomy on a patient [ 4 ]. EM residents are required to perform three cricothyrotomies during their training, either live or simulated, per the EM Residency Review Committee (RRC) guidelines [ 5 ].…”

Every Surgical Resident Should Know How to Perform a Cricothyrotomy: An Inexpensive Cricothyrotomy Task Trainer for Teaching and Assessing Surgical Trainees

“…Unfortunately, nearly half (48%) of graduating emergency medicine residents have never witnessed a cricothyrotomy, 1 and only 22% of emergency medicine graduates have performed a cricothyrotomy on a living patient. General surgery residents perform an average of 15 tracheostomies in 5 years of training, according to the Accreditation Council for Graduate Medical Education case logs, but the subset of these that are cricothyroidotomies is not reported.…”

“…2 Overall, residents' experience with cricothyrotomies across disciplines is limited and declining. 1,[3][4][5][6][7] Although residents and staff in general surgery, anesthesiology, and emergency medicine are knowledgeable in basic airway management to varying degrees, the conditions of a true "cannot ventilate, cannot intubate" patient rarely arise. As such, opportunities to gain experience in performing this procedure are scarce.…”