title: Role of contextualizing a crisis scenario on the performance of a cricothyrotomy procedural task.
abstract: OBJECTIVE
  Simulation is an important alternative to evaluate cricothyrotomy, a rare life-saving procedure. This crossover study aimed to determine whether contextualization of a crisis scenario would impact the performance of a cricothyrotomy procedural task.
  
  
  METHODS
  Sixty-five anesthesia assistants and emergency medicine and anesthesia residents underwent a teaching session in surgical cricothyrotomy using one of two sets of cricothyrotomy kits: the Portex 6.0 and Melker 3.5 (n = 32) or the Portex 6.0 and Melker 5.0 (n = 33). Within six weeks following the session, the participants performed cricothyrotomies on a full-body patient mannequin simulator coupled with a porcine larynx (tissue-mannequin simulator) using the assigned two kits in a "cannot intubate, cannot ventilate" (CICV) contextualized scenario (CS) and in a CICV verbalized non-contextualized scenario (NCS). Each participant performed a total of four cricothyrotomies using the two kits in the two scenarios. The primary outcome measure was insertion time, and secondary outcome measures were severity of injuries and failure rate. Outcome measures were compared between scenarios for each kit.
  
  
  RESULTS
  Mean (SD) insertion time for a successful cricothyrotomy was not significantly different between NCS and CS for the Melker 3.5 [83.0 (45.0) sec vs 63.3 (36.1) sec, respectively; P = 0.96; mean difference (MD), 19.7 sec; 95% confidence interval (CI), -1.9 to 41.3], the Melker 5.0 [86.5 (36.8) sec vs 107.1 (55.6) sec, respectively; P = 0.11; MD, -20.6 sec; 95% CI, -44.9 to 3.7], and the Portex 6.0 [59.5 (35.5) sec vs 59.0 (35.0) sec, respectively; P = 0.95; MD, 0.5 sec; 95% CI, -13.2 to 14.2]. Failure rate and severity of injuries, measured as mean average injury score for each kit, were also similar between scenarios.
  
  
  CONCLUSIONS
  Contextualization of a crisis scenario did not affect the performance of a cricothyrotomy procedural task on a tissue-mannequin simulator. These findings may have implications when considering the feasibility and cost-effectiveness for assessing the performance of cricothyrotomy procedural tasks.
authors.affiliation: Department of Anesthesia and Pain Management, Mount Sinai Hospital, 600 University Avenue, Toronto, ON, M5G 1X5, Canada, eyou-ten@mtsinai.on.ca.
authors.forename: Kong E
authors.initials: KE
authors.lastname: You-Ten
authors.forename: Catherine
authors.initials: C
authors.lastname: Wong
authors.forename: Cristian
authors.initials: C
authors.lastname: Arzola
authors.forename: Jessica
authors.initials: J
authors.lastname: Cheung
authors.forename: Zeev
authors.initials: Z
authors.lastname: Friedman
authors.forename: Sev
authors.initials: S
authors.lastname: Perelman
authors.forename: Naveed
authors.initials: N
authors.lastname: Siddiqui
mesh_terms: D000776:Anesthesiology / Q000193:education*; D000818:Animals; D002983:Clinical Competence; D003413:Cricoid Cartilage / Q000601:surgery*; D018592:Cross-Over Studies; D004630:Emergencies; D006801:Humans; D007396:Internship and Residency; D007830:Larynx; D008348:Manikins; D013552:Swine; D013957:Thyroid Cartilage / Q000601:surgery*; D013997:Time Factors