Performance of emergency surgical front of neck airway access by head and neck surgeons, general surgeons, or anaesthetists: an in situ simulation study: Who is best to perform a surgical cricothyroidotomy?

Peter Groom, Louise Schofield, Natasha Hettiarachchi, Samuel Pickard, JEREMY BROWN, JOHN SANDARS, Ben Morton

Research output: Contribution to journalArticle

Abstract

BACKGROUND The “Can’t Intubate Can’t Oxygenate” (CICO) emergency requires urgent front of neck airway access to prevent death. In cases reported to the 4th National Audit Project, the most successful front of neck airway (FONA) was a surgical technique, almost all of which were performed by surgeons. Subsequently, UK guidelines adopted surgical cricothyroidotomy as the preferred
emergency surgical FONA technique. Despite regular skills-based training, anaesthetists may still be unwilling to perform an emergency surgical FONA.

AIM To compare consultant anaesthetists, head and neck surgeons and general surgeons in a high-fidelity simulated emergency. We hypothesised that head and neck surgeons would successfully execute emergency surgical FONA faster than anaesthetists and general surgeons.

METHODS We recruited 15 consultants from each specialty (total 45). All agreed to participate in an in-situ hi-fidelity simulation of an ‘anaesthetic emergency’. Participants were not told in advance that this would be a CICO scenario.

RESULTS There was no significant difference in total time to successful ventilation between the three groups (median 86 vs. 98 vs. 126.5 seconds, p=0.078). However, anaesthetists completed the emergency surgical FONA procedure significantly faster than general surgeons (median 50 vs. 86 seconds, p=0.018). Despite this strong performance, qualitative data suggested some anaesthetists still believed ‘surgeons’ best placed to perform emergency surgical FONA in a genuine CICO situation.

CONCLUSION Anaesthetists regularly trained in emergency emergency surgical FONA function at levels comparable to head and neck surgeons and should feel empowered to lead this procedure in the event of a CICO emergency.
Original languageEnglish
JournalBritish Journal of Anaesthesia
Early online date23 Aug 2019
DOIs
Publication statusE-pub ahead of print - 23 Aug 2019

Fingerprint

Emergencies
Neck
Head
Consultants
Anesthetists
Surgeons
Ventilation
Anesthetics
Guidelines

Keywords

  • Airway Obstruction
  • Trachestomy
  • Surgical training
  • High Fidelity Simulation training
  • Surgical Cricothyroidotomy
  • surgical training
  • tracheostomy

Cite this

@article{8cc775f3c9df459a876c17d30eaaf4d8,
title = "Performance of emergency surgical front of neck airway access by head and neck surgeons, general surgeons, or anaesthetists: an in situ simulation study: Who is best to perform a surgical cricothyroidotomy?",
abstract = "BACKGROUND The “Can’t Intubate Can’t Oxygenate” (CICO) emergency requires urgent front of neck airway access to prevent death. In cases reported to the 4th National Audit Project, the most successful front of neck airway (FONA) was a surgical technique, almost all of which were performed by surgeons. Subsequently, UK guidelines adopted surgical cricothyroidotomy as the preferredemergency surgical FONA technique. Despite regular skills-based training, anaesthetists may still be unwilling to perform an emergency surgical FONA.AIM To compare consultant anaesthetists, head and neck surgeons and general surgeons in a high-fidelity simulated emergency. We hypothesised that head and neck surgeons would successfully execute emergency surgical FONA faster than anaesthetists and general surgeons.METHODS We recruited 15 consultants from each specialty (total 45). All agreed to participate in an in-situ hi-fidelity simulation of an ‘anaesthetic emergency’. Participants were not told in advance that this would be a CICO scenario.RESULTS There was no significant difference in total time to successful ventilation between the three groups (median 86 vs. 98 vs. 126.5 seconds, p=0.078). However, anaesthetists completed the emergency surgical FONA procedure significantly faster than general surgeons (median 50 vs. 86 seconds, p=0.018). Despite this strong performance, qualitative data suggested some anaesthetists still believed ‘surgeons’ best placed to perform emergency surgical FONA in a genuine CICO situation.CONCLUSION Anaesthetists regularly trained in emergency emergency surgical FONA function at levels comparable to head and neck surgeons and should feel empowered to lead this procedure in the event of a CICO emergency.",
keywords = "Airway Obstruction, Trachestomy, Surgical training, High Fidelity Simulation training, Surgical Cricothyroidotomy, surgical training, tracheostomy",
author = "Peter Groom and Louise Schofield and Natasha Hettiarachchi and Samuel Pickard and JEREMY BROWN and JOHN SANDARS and Ben Morton",
year = "2019",
month = "8",
day = "23",
doi = "10.1016/j.bja.2019.07.011",
language = "English",
journal = "British Journal of Anaesthesia",
issn = "0007-0912",
publisher = "Elsevier Ltd",

}

TY - JOUR

T1 - Performance of emergency surgical front of neck airway access by head and neck surgeons, general surgeons, or anaesthetists: an in situ simulation study

T2 - Who is best to perform a surgical cricothyroidotomy?

AU - Groom, Peter

AU - Schofield, Louise

AU - Hettiarachchi, Natasha

AU - Pickard, Samuel

AU - BROWN, JEREMY

AU - SANDARS, JOHN

AU - Morton, Ben

PY - 2019/8/23

Y1 - 2019/8/23

N2 - BACKGROUND The “Can’t Intubate Can’t Oxygenate” (CICO) emergency requires urgent front of neck airway access to prevent death. In cases reported to the 4th National Audit Project, the most successful front of neck airway (FONA) was a surgical technique, almost all of which were performed by surgeons. Subsequently, UK guidelines adopted surgical cricothyroidotomy as the preferredemergency surgical FONA technique. Despite regular skills-based training, anaesthetists may still be unwilling to perform an emergency surgical FONA.AIM To compare consultant anaesthetists, head and neck surgeons and general surgeons in a high-fidelity simulated emergency. We hypothesised that head and neck surgeons would successfully execute emergency surgical FONA faster than anaesthetists and general surgeons.METHODS We recruited 15 consultants from each specialty (total 45). All agreed to participate in an in-situ hi-fidelity simulation of an ‘anaesthetic emergency’. Participants were not told in advance that this would be a CICO scenario.RESULTS There was no significant difference in total time to successful ventilation between the three groups (median 86 vs. 98 vs. 126.5 seconds, p=0.078). However, anaesthetists completed the emergency surgical FONA procedure significantly faster than general surgeons (median 50 vs. 86 seconds, p=0.018). Despite this strong performance, qualitative data suggested some anaesthetists still believed ‘surgeons’ best placed to perform emergency surgical FONA in a genuine CICO situation.CONCLUSION Anaesthetists regularly trained in emergency emergency surgical FONA function at levels comparable to head and neck surgeons and should feel empowered to lead this procedure in the event of a CICO emergency.

AB - BACKGROUND The “Can’t Intubate Can’t Oxygenate” (CICO) emergency requires urgent front of neck airway access to prevent death. In cases reported to the 4th National Audit Project, the most successful front of neck airway (FONA) was a surgical technique, almost all of which were performed by surgeons. Subsequently, UK guidelines adopted surgical cricothyroidotomy as the preferredemergency surgical FONA technique. Despite regular skills-based training, anaesthetists may still be unwilling to perform an emergency surgical FONA.AIM To compare consultant anaesthetists, head and neck surgeons and general surgeons in a high-fidelity simulated emergency. We hypothesised that head and neck surgeons would successfully execute emergency surgical FONA faster than anaesthetists and general surgeons.METHODS We recruited 15 consultants from each specialty (total 45). All agreed to participate in an in-situ hi-fidelity simulation of an ‘anaesthetic emergency’. Participants were not told in advance that this would be a CICO scenario.RESULTS There was no significant difference in total time to successful ventilation between the three groups (median 86 vs. 98 vs. 126.5 seconds, p=0.078). However, anaesthetists completed the emergency surgical FONA procedure significantly faster than general surgeons (median 50 vs. 86 seconds, p=0.018). Despite this strong performance, qualitative data suggested some anaesthetists still believed ‘surgeons’ best placed to perform emergency surgical FONA in a genuine CICO situation.CONCLUSION Anaesthetists regularly trained in emergency emergency surgical FONA function at levels comparable to head and neck surgeons and should feel empowered to lead this procedure in the event of a CICO emergency.

KW - Airway Obstruction

KW - Trachestomy

KW - Surgical training

KW - High Fidelity Simulation training

KW - Surgical Cricothyroidotomy

KW - surgical training

KW - tracheostomy

U2 - 10.1016/j.bja.2019.07.011

DO - 10.1016/j.bja.2019.07.011

M3 - Article

JO - British Journal of Anaesthesia

JF - British Journal of Anaesthesia

SN - 0007-0912

ER -