The impact of didactic read‐aloud action cards on the performance of cannula cricothyroidotomy in a simulated ‘can't intubate can't oxygenate’ scenario

• Published in: Anaesthesia Vol. 72; no. 3; pp. 343 - 349
• Main Authors: Harvey, R., Foulds, L., Housden, T., Bennett, K. A., Falzon, D., McNarry, A. F., Graham, C.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.03.2017
• Subjects: Airway management; Airway Management - methods; Airway Obstruction - surgery; Anesthesia; Cannula; Checklist; Clinical Competence; Cricoid Cartilage - surgery; difficult airway algorithm; Emergencies; failed intubation: treatment; front‐of‐neck access; human factors: cognitive aids; Humans; Intraoperative Care - methods; Intubation; Scotland; Simulation; Thyroid Cartilage - surgery; Tracheotomy - methods; Tracheotomy - standards; failed intubation: treatment; human factors: cognitive aids; difficult airway algorithm; front-of-neck access
• ISSN: 0003-2409; 1365-2044
• DOI: 10.1111/anae.13643

Summary 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.