Assessing anesthesiology residents’ out-of-the-operating-room (OOOR) emergent airway management

Abstract

BackgroundAt many academic institutions, anesthesiology residents are responsible for managing emergent intubations outside of the operating room (OOOR), with complications estimated to be as high as 39%. In order to create an OOOR training curriculum, we evaluated residents’ familiarity with the content and correct adherence to the American Society of Anesthesiologists’ Difficult Airway Algorithm (ASA DAA).MethodsResidents completed a pre-simulation multiple-choice survey measuring their understanding and use of the DAA. Residents then managed an emergent, difficult OOOR intubation in the simulation center, where two trained reviewers assessed performance using checklists. Post-simulation, the residents completed a survey rating their behaviors during the simulation. The primary outcome was comprehension and adherence to the DAA as assessed by survey responses and behavior in the simulation.ResultsSixty-three residents completed both surveys and the simulation. Post-survey responses indicated a shift toward decreased self-perceived familiarity with the DAA content compared to pre-survey responses. During the simulation, 22 (35%) residents were unsuccessful with intubation. Of these, 46% placed an LMA and 46% prepared for cricothyroidotomy. Nineteen residents did not attempt intubation. Of these, only 31% considered LMA placement, and 26% initiated cricothyroidotomy.ConclusionsMany anesthesiology residency training programs permit resident autonomy in managing emergent intubations OOOR. Residents self-reported familiarity with the content of and adherence to the DAA was higher than that observed during the simulation. Curriculum focused on comprehension of the DAA, as well as improving communication with higher-level physicians and specialists, may improve outcomes during OOORs.Electronic supplementary materialThe online version of this article (doi:10.1186/s12871-017-0387-2) contains supplementary material, which is available to authorized users.

Difficult airway management algorithms: a directed review

“…There were 55 articles that discussed or investigated the implementation, adherence or knowledge retention of airway algorithms (Appendix S2). Of these, 44 (80%) focused solely on society‐produced algorithms . Five focused on non‐society‐produced algorithms and six included both in their analysis .…”

“…This was followed by algorithms published by the ASA, with ASA 1993 being referred to in 13 (24%) of the included papers . Moreover, ASA 2013 was referred to in a further 11 (20%) of the included papers . The Vortex was the most commonly referred to non‐society algorithm (n = 4, 7%) .…”

“…Of the observational and interventional papers, the methodological quality of these articles primarily ranged from low to medium according to MERSQI and CASP (Appendix S2) . Of the non‐algorithm studies, algorithm adherence was the most common outcome measurement (n = 14) . Other primary outcomes included the effects of simulated training on algorithm compliance (n = 4) and the effects of algorithms on clinical practice (n = 2) .…”

“…. Variable adherence among practitioners was reported, as clinicians with greater clinical experience reported higher rates of adherence to airway management algorithms .…”

Emergent airway management outside of the operating room – a retrospective review of patient characteristics, complications and ICU stay

“…Most likely the lower incidence in this study is explained by the extensive airway training and simulation program we perform to prepare physcians for emergent airway managements outside the OR. The importance of airway education for airway management outside th eopreating room has been described by Rochlen et al [10] In general, repeated attempts at tracheal intubation should be avoided because they increase the incidence of airway obstruction, leading to serious airway complications [11, 12].…”