engleski

A HITCHHIKER’S GUIDE TO CUTTING THE NECK OR HOW TO TEACH CRICOTHYROTOMY TO EMERGENCY MEDICINE RESIDENTS

Introduction: Every physician doing airway management on a daily basis, regardless of their medical specialty, has a “failed airway” algorithm memorised and internalised, in case they encounter a difficult airway that cannot be managed by traditional, non-surgical methods like placement of a supraglottic device or an endotracheal tube. Most failed airway algorithms contain cricothyrotomy as a final “rescue” method of establishing an airway when every other procedure fails. However, cutting the neck and doing a highly invasive procedure with a number of possible complications, along with the fact that acquiring real-life experience with the procedure is logistically difficult, present a significant hurdle to physicians mastering this life-saving procedure. This paper aims to review and gather the different training methods used to educate physicians in cricothyrotomy and compare their effectiveness. Discussion: A search of the available literature was performed using PubMed and Google Scholar, with the search yielding 7 original research papers describing various methods of cricothyrotomy training after the filtration process. There were several important points inferred from the papers analysed. First of all, the number of cricothyrotomy attemps on mannequins and various teaching models necessary for an untrained physician to perform a successful cricothyrotomy in less than 40 seconds was five, with the study participants achieving a success rate of 96% in 5 procedure attempts. Secondly, it has been shown that cricothyrotomy training on mannequins improved adherence to the “failed airway” algorithms, with 0% of the group trained in cricothyrotomy and 50% of the non-trained group commiting at least one major deviation from the algorithm. Furthermore, even the most basic cricothyrotomy training has been shown to drastically increase physician confidence in choosing and performing cricothyrotomies, with the most extreme example showing a rise in reported participants’ self-confidence of 88% after a single 50 minute hands-on workshop. Finally, with the advent of new technologies, increasingly effective teaching modalities have presented themselves. One of the papers reviewed describes a virtual reality teaching model, with extremely encouraging results: All of the study participants taught using virtual reality reached proficiency in the procedure with a clinically acceptable failure rate in only 2 weeks of active training. Conclusion: Cricothyrotomy should be taught to all physicians doing airway management, be it with animal models, 3D printed mannequins or virtual reality, as even minimal training has shown to provide drastic improvements in trainee confidence and proficiency with the technique

education ; emergency medicine ; simulation training

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