S DeMaria1, D J Berman2, A Goldberg1, H-M Lin1, Y Khelemsky1, A I Levine1. 1. Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place Box 1010, New York, NY 10029, USA. 2. Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place Box 1010, New York, NY 10029, USA daveberman@gmail.com.
Abstract
BACKGROUND: Non-operating room (non-OR) airway management has previously been identified as an area of concern because it carries a significant risk for complications. One reason for this could be attributed to the independent practice of residents in these situations. The aim of the present study was to ascertain whether differences in performance exist between residents working alone vs with a resident partner when encountering simulated non-OR airway management scenarios. METHODS: Thirty-six anaesthesia residents were randomized into two groups. Each group experienced three separate scenarios (two scenarios initially and then a third 6 weeks later). The scenarios consisted of one control scenario and two critical event scenarios [i.e. asystole during laryngoscopy and pulseless electrical activity (PEA) upon post-intubation institution of positive pressure ventilation]. One group experienced the simulated non-OR scenarios alone (Solo group). The other group consisted of resident pairs, participating in the same three scenarios (Team group). RESULTS: Although the time to intubation did not differ between the Solo and Team groups, there were several differences in performance. The Team group received better overall performance ratings for the asystole (8.5 vs 5.5 out of 10; P<0.001) and PEA (8.5 vs 5.8 out of 10; P<0.001) scenarios. The Team group was also able to recognize asystole and PEA conditions faster than the Solo group [10.1 vs 23.5 s (P<0.001) and 13.3 vs 36.0 s (P<0.001), respectively]. CONCLUSIONS: Residents who performed a simulated intubation with a second trained provider had better overall performance than those who practised independently. The residents who practised in a group were also faster to diagnose serious complications, including peri-intubation asystole and PEA. Given these data, it is reasonable that training programmes consider performing all non-OR airway management with a team-based method.
BACKGROUND: Non-operating room (non-OR) airway management has previously been identified as an area of concern because it carries a significant risk for complications. One reason for this could be attributed to the independent practice of residents in these situations. The aim of the present study was to ascertain whether differences in performance exist between residents working alone vs with a resident partner when encountering simulated non-OR airway management scenarios. METHODS: Thirty-six anaesthesia residents were randomized into two groups. Each group experienced three separate scenarios (two scenarios initially and then a third 6 weeks later). The scenarios consisted of one control scenario and two critical event scenarios [i.e. asystole during laryngoscopy and pulseless electrical activity (PEA) upon post-intubation institution of positive pressure ventilation]. One group experienced the simulated non-OR scenarios alone (Solo group). The other group consisted of resident pairs, participating in the same three scenarios (Team group). RESULTS: Although the time to intubation did not differ between the Solo and Team groups, there were several differences in performance. The Team group received better overall performance ratings for the asystole (8.5 vs 5.5 out of 10; P<0.001) and PEA (8.5 vs 5.8 out of 10; P<0.001) scenarios. The Team group was also able to recognize asystole and PEA conditions faster than the Solo group [10.1 vs 23.5 s (P<0.001) and 13.3 vs 36.0 s (P<0.001), respectively]. CONCLUSIONS: Residents who performed a simulated intubation with a second trained provider had better overall performance than those who practised independently. The residents who practised in a group were also faster to diagnose serious complications, including peri-intubation asystole and PEA. Given these data, it is reasonable that training programmes consider performing all non-OR airway management with a team-based method.
Authors: Dimitrios Stefanidis; James R Korndorffer; Sarah Markley; Rafael Sierra; Daniel J Scott Journal: J Am Coll Surg Date: 2006-04 Impact factor: 6.113
Authors: William J Benedetto; Dean R Hess; Elise Gettings; Luca M Bigatello; Hannah Toon; William E Hurford; Ulrich Schmidt Journal: J Clin Anesth Date: 2007-02 Impact factor: 9.452
Authors: Lynette J Mark; Kurt R Herzer; Renee Cover; Vinciya Pandian; Nasir I Bhatti; Lauren C Berkow; Elliott R Haut; Alexander T Hillel; Christina R Miller; David J Feller-Kopman; Adam J Schiavi; Yanjun J Xie; Christine Lim; Christine Holzmueller; Mueen Ahmad; Pradeep Thomas; Paul W Flint; Marek A Mirski Journal: Anesth Analg Date: 2015-07 Impact factor: 6.627