title: The impact of didactic read-aloud action cards on the performance of cannula cricothyroidotomy in a simulated 'can't intubate can't oxygenate' scenario.
abstract: Significant benefits have been demonstrated with the use of peri-operative checklists. We assessed whether a read-aloud didactic action card would improve performance of cannula cricothyroidotomy in a simulated 'can't intubate, can't oxygenate' scenario. A 17-step action card was devised by an expert panel. Participants in their first 4 years of anaesthetic training were randomly assigned into 'no-card' or 'card' groups. Scenarios were video-recorded for analysis. Fifty-three participants (27 no-card and 26 card) completed the scenario. The number of steps omitted was mean (SD) 6.7 (2.0) in the no-card group vs. 0.3 (0.5); p < 0.001 in the card group, but the no-card group was faster to oxygenation by mean (95% CI) 35.4 (6.6-64.2) s. The Kappa statistic was 0.84 (0.73-0.95). Our study demonstrated that action cards are beneficial in achieving successful front-of-neck access using a cannula cricothyroidotomy technique. Further investigation is required to determine this tool's effectiveness in other front-of-neck access situations, and its role in teaching or clinical management.
authors: Department of Anaesthesia, Borders General Hospital, Melrose, UK.
authors: R
authors: R
authors: Harvey
authors: Department of Anaesthesia, Ninewell's Hospital, Dundee, UK.
authors: L
authors: L
authors: Foulds
authors: Department of Anaesthesia, St John's Hospital, NHS Lothian, Livingston, UK.
authors: T
authors: T
authors: Housden
authors: Department of Anaesthesia, Wishaw General Hospital, Wishaw, UK.
authors: K A
authors: KA
authors: Bennett
authors: Department of Anaesthesia, Edinburgh Royal Infirmary, NHS Lothian, Edinburgh, UK.
authors: D
authors: D
authors: Falzon
authors: Departments of Anaesthesia, The Western General and St John's Hospital, NHS Lothian, Edinburgh, UK.
authors: A F
authors: AF
authors: McNarry
authors: Epidemiology and Statistics Core, Wellcome Trust Clinical Research Facility, University of Edinburgh, Edinburgh, UK.
authors: C
authors: C
authors: Graham
mesh_terms: D058109:Airway Management / Q000379:methods*; D000402:Airway Obstruction / Q000601:surgery*; D000072601:Cannula; D057189:Checklist; D002983:Clinical Competence; D003413:Cricoid Cartilage / Q000601:surgery; D004630:Emergencies; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D012606:Scotland; D013957:Thyroid Cartilage / Q000601:surgery; D014140:Tracheotomy / Q000379:methods / Q000592:standards*
keywords: difficult airway algorithm; failed intubation: treatment; front-of-neck access; human factors: cognitive aids