Who teaches surgical airway management and how do they teach it? A survey of United States anesthesiology training programs

Holak, Elena J.; Kaslow, Olga; Pagel, Paul S.

doi:10.1016/j.jclinane.2010.10.002

Cited by 14 publications

(13 citation statements)

References 30 publications

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“…The use of each of these methods of instruction is well documented in the literature, but their use relative to each other and residents’ ultimate degree of comfort with respect to cricothyrotomy were previously unknown 7,12,18…”

Section: Discussionmentioning

confidence: 99%

“…The mortality rate among trauma patients in this study is similar to that found in the literature, but residents reported a greater than expected number of complications during performance of their most recent cricothyrotomy 27. This may indicate that a sicker population was sampled, that too much time was spent using adjunct devices before resorting to a cric, that physicians’ clinical skills have deteriorated as experience with cricothyrotomy has declined, that the procedure is being done as a peri-mortem event for teaching purposes, or that other non-quantifiable factors are present 8,12. Further study regarding the nature and causes of complications is needed.…”

Section: Discussionmentioning

confidence: 99%

“…Surgical airway remains the final step in the American Society of Anesthesiologist’s Practice Guidelines for Management of the Difficult Airway, and emergency physicians have faced litigation for failing to perform a cricothyrotomy when intubation and rescue devices have failed 12,13,14. The Residency Review Committee (RRC) for EM stipulates that a resident shall complete at least 3 cricothyrotomies by graduation, but procedure logs do not distinguish among those performed on models/simulators, animals, the deceased, or living patients 15.…”

Section: Introductionmentioning

confidence: 99%

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A Survey of Graduating Emergency Medicine Residents' Experience with Cricothyrotomy

Makowski¹

2013

WestJEM

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Survey of Graduating Emergency Medicine Residents' Experience with Cricothyrotomy

Makowski¹

2013

WestJEM

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“…27,39,40 Birnbaumer recently summarized the pros and cons of cadaver in stating that they have "already given consent" and reflect actual human anatomy but they are expensive and their availability is limited and requires dedicated facilities and staff. 41 Fresh cadavers can only be used in a limited period of time and may transmit disease while fixed cadavers' tissues may be less realistic.…”

Section: How Should We Teach Awm?mentioning

confidence: 99%

Evidence base in airway management training

Zoric

Savoldelli

2015

Trends in Anaesthesia and Critical Care

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“…Various training modalities, including human cadavers, animal models, synthetic models, and virtual reality simulators, have been used to simulate microlaryngoscopy and microsurgery, tonsillectomy, needle biopsy of thyroid nodules, and cricothyroidotomy . Synthetic three‐dimensionally printed simulators are able to create highly accurate anatomical representations of human anatomy and have undergone early validation for airway procedures .…”

Section: Introductionmentioning

confidence: 99%

Live porcine model for surgical training in tracheostomy and open‐airway surgery

et al. 2019

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Objectives/Hypothesis To evaluate the validity of a live porcine model for surgical training in tracheostomy and open‐airway surgery. Study Design Prospective observational study. Methods Eleven expert otolaryngologists–head and neck surgeons rated a live porcine model's realism/anatomical accuracy (face validity) and perceived effectiveness as a training tool (content validity) for tracheostomy and laryngotracheoplasty using anterior costal cartilage and thyroid ala cartilage grafts using a 53‐item post‐trial questionnaire with a five‐point Likert scale. Results Experts rated the face validity of the live porcine model a median (interquartile range [IQR]) of 4/5 (4–5) and the content validity a median (IQR) of 5/5 (4–5) for each surgical procedure. Overall, 91% strongly agreed or agreed that the simulator would increase trainee competency for tracheostomy and laryngotracheoplasty using costal cartilage graft, and 82% strongly agreed or agreed that it would increase trainee competency for laryngotracheoplasty using thyroid ala cartilage graft. Conclusions The live porcine model has high face and content validity as a training tool for tracheostomy and laryngotracheoplasty using costal cartilage and thyroid ala cartilage grafts. This training model can help surgical trainees practice these complex, low‐frequency procedures. Level of Evidence NA Laryngoscope, 130: 2063–2068, 2020

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Who teaches surgical airway management and how do they teach it? A survey of United States anesthesiology training programs

Cited by 14 publications

References 30 publications

A Survey of Graduating Emergency Medicine Residents' Experience with Cricothyrotomy

A Survey of Graduating Emergency Medicine Residents' Experience with Cricothyrotomy

Evidence base in airway management training

Live porcine model for surgical training in tracheostomy and open‐airway surgery

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