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How to Teach Invasive Airway Access So It Sticks

March 28, 2022

Written by Clay Smith

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A high-fidelity simulation training program was very effective in teaching anesthesiologists to place invasive subglottic airways; skill retention was outstanding as well.

Why does this matter?
Anesthesiologists and emergency physicians rarely need to place an invasive airway, yet it’s a skill that can make the difference between life and death. Given the infrequency of this type of procedure, is there a simulated way to learn and retain these skills?

Learn on a manikin before wielding scalpels on patients…
Sixty board-certified academic anesthesiologists, an average of 8.7 years post-residency, were tested and skills-trained on transtracheal jet ventilation (TTJV) and bougie cricothyrotomy placement (BC) using high fidelity simulation (Laerdal SimMan 3G human simulator). Prior to training, they were each tested on the skills with just the instructor and were successful at TTJV placement about 15% of the time and BC 20% of the time. After a 2.5 hour mastery-based learning (MBL) simulation, with the doctors learning in pairs, 100% were successful with all techniques, and 80% retained the skills over a year later. The fastest method was BC. It took about 6 minutes to master TTJV and an average of 4 attempts. It took about 4 minutes and median 3 attempts to master BC. Part of MBL was repeating the skill until they could do it flawlessly and then overtraining by doing it two additional times. The course was taught by a single physician airway training expert. The effectiveness of other instructors could vary, raising questions about the generalizability of these results. Also, manikins aren’t morbidly obese, don’t have edema, and don’t bleed, which may decrease success rates in real patients. However, wait until you see tomorrow’s post. Turns out manikins can be “obese” and can “bleed.”

Emergency Subglottic Airway Training and Assessment of Skills Retention of Attending Anesthesiologists With Simulation Mastery-Based Learning. Anesth Analg. 2022 Feb 10. doi: 10.1213/ANE.0000000000005928. Online ahead of print.

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