A mixed-methods pilot study to evaluate a collaborative anaesthetic and surgical training package for emergency surgical cricothyroidotomy

R J Berwick, W Gauntlett, S. A. Silverio , H. Wallace, Simon Mercer, JEREMY BROWN, JOHN SANDARS, B. Morton , P. Groom

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In a ‘can’t intubate, can’t oxygenate’ (CICO) scenario success of emergency front of neck access (FONA), is dependent upon a clinician’s skill, competence and confidence to initiate the procedure. Surgical cricothyroidotomy (SCT) is an important airway skill as it can be employed as both the pri-mary method of emergency FONA or as a rescue approach, should a needle technique fail. We de-signed a collaborative surgical and anaesthetic training package to address perceived anaesthetic reluctance to perform SCT and undertook a pilot study of the package using a mixed methods ap-proach. The package consisted of three elements: theory teaching, surgical experience and re-peated high-fidelity simulation.

Ten anaesthetic trainees were trained using the package. Training was comprised of face-to-face tuition on the 2015 Difficult Airway Society (DAS) guidelines, Vortex cognitive aid, manikin-based SCT instruction and surgical experience gained from an elective surgical tracheostomy. A standard-ised, high-fidelity in-situ CICO simulation was used to assess performance at baseline, two weeks and six months post-training. Participants scored their self-efficacy, underwent qualitative semi-structured interviews and had their performance quantitatively assessed to evaluate this training.

Six months’ post training, participant’s performance had improved: they reported significantly in-creased self-efficacy and demonstrated significantly reduced deliberation time to initiate SCT in the simulated CICO emergency. Thematic framework analysis of interview transcripts revealed that reluctance to perform SCT was related to fear and anxiety performing the procedure.

These results support wider adoption of collaborative educational training packages, including hands-on surgical teaching, to improve trainees’ efficacy and confidence with SCT and FONA in an emergency CICO scenario.
Original languageEnglish
Pages (from-to)357-367
JournalAnaesthesia and Intensive Care
Issue number4
Early online date19 Aug 2019
Publication statusPublished - 2019


  • Airway obstruction
  • High-fidelity simulation training
  • Surgical training
  • Tracheostomy

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