Abstract:
This CE webinar demonstrates the use of healthcare simulation in training two methods of cricothyrotomy: the scalpel-bougie technique and the Seldinger technique in a can’t-intubate-can’t-ventilate simulation scenario in anesthesia.
This project stemmed from the occurrence of several airway disasters in recent years at the University of Iowa Hospitals and Clinics. In analyzing these mishaps, clinical instructors realized there was a lack of sufficient training in the performance of a cricothyrotomy as well as delays in the decision-making process to go to a surgical airway when in a can’t intubate/can’t ventilate (CICV) situation. We were thus tasked to develop this quality improvement initiative to consist of a difficult airway simulation training for all clinical providers in the Department of Anesthesia. We developed the simulation scenario setting to take place in the operating room. We utilized a high-fidelity mannequin with all relevant monitors and interactions. There were 3-4 trainees for each training session.
Each training session consisted of the following: An initial healthcare simulation of the clinical scenario involves an unexpected difficult airway following the induction of anesthesia, which evolves into a can’t-intubate-can’t-ventilate situation.
The medical simulation is paused at this point to allow for a discussion of the simple algorithm we developed to aid the clinician’s decision-making process to proceed to a surgical airway. Trainees are then introduced to the Universal Emergency Cricothyrotomy Kit (Melker) and both cricothyrotomy techniques (Seldinger and scalpel-bougie) are discussed. Next, trainees then practice the two different techniques on porcine tracheas covered with either porcine skin or silicone-simulated skin. Clinicians then repeat the CICV simulation scenario, this time trainees use the algorithm to guide the decision to proceed with cricothyrotomy, using the preferred technique of their choice.
Learning Objectives:
- To improve the clinician’s decision-making process to proceed to the surgical airway when faced with a can’t intubate-can’t ventilate (CICV) scenario.
- To familiarize clinicians with two methods of cricothyrotomy: The scalpel-bougie technique and the Seldinger technique.
- Learn why every clinician should finish the training with a clear preference for the cricothyrotomy technique, which will serve as their primary choice in a CICV clinical scenario.
