The impact of didactic read-aloud action cards on the performance of cannula cricothyroidotomy in a simulated 'can't intubate can't oxygenate' scenario.
Harvey R1, Foulds L2, Housden T3, Bennett KA4, Falzon D5, McNarry AF6, Graham C7.
Author information
1
Department of Anaesthesia, Borders General Hospital, Melrose, UK.
2
Department of Anaesthesia, Ninewell's Hospital, Dundee, UK.
3
Department of Anaesthesia, St John's Hospital, NHS Lothian, Livingston, UK.
4
Department of Anaesthesia, Wishaw General Hospital, Wishaw, UK.
5
Department of Anaesthesia, Edinburgh Royal Infirmary, NHS Lothian, Edinburgh, UK.
6
Departments of Anaesthesia, The Western General and St John's Hospital, NHS Lothian, Edinburgh, UK.
7
Epidemiology and Statistics Core, Wellcome Trust Clinical Research Facility, University of Edinburgh, Edinburgh, UK.
Abstract
Significant benefits have been demonstrated with the use of peri-operative checklists. We assessed whether a read-aloud didactic action card would improve performance of cannula cricothyroidotomy in a simulated 'can't intubate, can't oxygenate' scenario. A 17-step action card was devised by an expert panel. Participants in their first 4 years of anaesthetic training were randomly assigned into 'no-card' or 'card' groups. Scenarios were video-recorded for analysis. Fifty-three participants (27 no-card and 26 card) completed the scenario. The number of steps omitted was mean (SD) 6.7 (2.0) in the no-card group vs. 0.3 (0.5); p < 0.001 in the card group, but the no-card group was faster to oxygenation by mean (95% CI) 35.4 (6.6-64.2) s. The Kappa statistic was 0.84 (0.73-0.95). Our study demonstrated that action cards are beneficial in achieving successful front-of-neck access using a cannula cricothyroidotomy technique. Further investigation is required to determine this tool's effectiveness in other front-of-neck access situations, and its role in teaching or clinical management.

© 2016 The Association of Anaesthetists of Great Britain and Ireland.

KEYWORDS:
difficult airway algorithm; failed intubation: treatment; front-of-neck access; human factors: cognitive aids

PMID: 27797158 DOI: 10.1111/anae.13643