Integration of Pre-intubation Ultrasound into Airway Management Course: A Novel Training Program

Abstract

Objectives:To determine the feasibility of integrating pre-intubation ultrasound into airway course and assess emergency medicine (EM) residents' confidence and comfort level in using ultrasound for pre-intubation hemodynamic stabilization and identifying cricothyroid membrane after the training session. Materials and methods: This is a retrospective study. Pre-intubation ultrasound training was delivered with the following ultrasound components (didactics and hands-on sessions using human models) to EM residents: (1) sonoanatomy and scanning technique to identify cricothyroid membrane and (2) pre-intubation echocardiography for recognition of acute right ventricular failure and pre-intubation hemodynamic stabilization. Results: A total of 56 EM residents participated in this study. Only 21% [95% confidence interval (CI), 10-31%] reported using ultrasound for pre-intubation hemodynamic stabilization. After the training session, 89% (95% CI, 81-97%) reported that ultrasound-based teaching increased their knowledge of pre-intubation hemodynamic stabilization compared with traditional teaching methods. On a scale of 1 (low) through 10 (high), the average comfort level for integrating ultrasound findings into medical decision making for pre-intubation hemodynamic stabilization was 6.8 (95% CI, 6.3-7.3). Seventy-nine percent (95% CI, 68-89%) reported that focused training in airway ultrasound is adequate to identify cricothyroid membrane. On a scale of 1 (low) through 10 (high), the average confidence level for identifying cricothyroid membrane using ultrasound was 6.6 (95% CI, 6.1-7.1). Conclusion: At our institution, we successfully integrated pre-intubation ultrasound into an airway course. Emergency medicine residents had a moderate level of comfort and confidence level using ultrasound for pre-intubation hemodynamic stabilization and identifying cricothyroid membrane after the training session.

Can ultrasound novices develop image acquisition skills after reviewing online ultrasound modules?

“…A short questionnaire was also administered at the end of the hands-on evaluation session. The previously piloted and validated paper questionnaire included items pertaining to opinions regarding the educational intervention and their image acquisition confidence level on a 1 to 10 scale [ 11 , 12 ].…”

Cricothyrotomy - In Unanticipated Difficult Intubation Cases with Respiratory Compromise

“…11 Preintubation ultrasound has been considered for increasing the rate of successful cricothyrotomies. 12 However, there is no gold standard for a difficult airway algorithm. 3 The primary objective of the present study is to compare and evaluate all three methods in terms of indications, duration of operating time, intraoperative and postoperative complications, and the instruments needed for each procedure.…”

Airway management in hospital. Methodological recommendations of the All-Russian public organization “Federation of Anesthesiologists and Reanimatologists” (third edition)

“…ň Рекомендация 8. Рекомендуется регулярное обучение специалистов методикам применения различных устройств и оборудования для проведения вентиляции и интубации, выполнению УЗ-обследования ВДП, шеи и желудка, технике выполнения инвазивного доступа к дыхательным путям, а также отработка алгоритмов действий во время критических ситуаций ТДП с использованием симуляционного оборудования различного уровня реалистичности [227][228][229][230][231] (УДД -3, УУР -С).…”