Transfer of airway skills from manikin training to patient: success of ventilation with facemask or LMA-Supreme^TMby medical students

Abstract

SummaryDuring emergency care, the ability to ventilate the patient's lungs is a crucial skill. Supraglottic airway devices have an established role in emergency care, and manikin trials have shown that placement is easy even for inexperienced users. However, there is current discussion as to what extent these results can be transferred to patients. We studied the transfer of skills learnt on a manikin to the clinical situation in novice medical students during their anaesthesia rotation. They were required to ventilate the lungs of a manikin using a facemask and then position a supraglottic airway device (LMA-Supreme TM ) and ventilate the lungs. This process was then repeated on anaesthetised patients, with standard ventilator settings to assess adequacy of ventilation. Sixty-three students participated in the manikin study. The success rate for ventilating the lungs was 100% for both devices, but the mean (SD) time to achieve successful ventilation was 27.8 (24.4) s with the facemask compared with 38.6 (22.0) s with the LMA-Supreme (p = 0.008). Fifty-one of the students progressed to the second part of the study. In anaesthetised patients, the success rate for ventilating the lungs was lower for the facemask, 27/41 (66%) compared with the LMA-Supreme 37/41 (90%, p = 0.006). For 26 students who succeeded with both devices, the tidal volume was lower using the facemask, 431 (192) ml compared with the LMA-Supreme 751 (221) ml (p = 0.001), but the time to successful ventilation did not differ, 60.0 (26.2) s vs 57.3 (26.6) s (p = 0.71). We conclude that the results obtained in manikin studies cannot be transferred directly to the clinical situation and that guidelines should take this into account. Based on our findings, a supraglottic airway device may be preferable to a facemask as the first choice for inexperienced emergency caregivers.

Trachway and jaw thrust

“…Russo and colleagues found that airway skills successfully practised on a manikin were not consistently effective when transferred to real patients [1]. Success rates for ventilation through a facemask were also significantly lower than through a supraglottic airway device.…”

“…Labelling syringe plungers to reduce medication errors I was interested to read the letter by Webster [1] regarding the colourcoding of prefilled syringes and the inconsistency of manufacturers to comply with the international standard. It is well known that syringeswap errors are a significant cause of complications in the operating theatre [2].…”

Evidence base in airway management training

“…Different alternative methods to clinical training have been described: cadaver practice for teaching cricothyroidotomy, 27 partial task trainers for simulated practice of various techniques (direct laryngoscopy, 28 extraglottic airway device (EAD) insertion, 29,30 videolaryngoscopes, fiberoptic intubation, cricothyroidotomy 31,32 ), computer-based or smart phone applications for teaching fiberoptic intubation, 33,34 videolaryngoscopes to demonstrate and teach ETI in simulated or real life settings, 35 full scale manikin simulation, 36e38 to name the most frequently used methods.…”

Präklinische Atemwegssicherung

“…Andererseits kommt hiermit ein Gerät im Notfall zum Einsatz, dessen Anwendung -im Gegensatz zu Larynxmasken -viel seltener in der perioperativen Routine am Patienten erlernt wird. Zwar scheint die Ventilation über eine SGA der Beatmung mithilfe einer Gesichtsmaske überlegen zu sein [12,13], welche SGA jedoch für die präklinische Notfallsituation das optimale Profil hat, kann aus den derzeitigen Studien nicht sicher abgeleitet, sondern muss aus den perioperativen Daten bei Elektivpatienten extrapoliert werden.…”