August FY23

[kristenhorsman]

The August journal club is presented by Kelsie Johnson and is titled "Mobile Cricothyrotomy Simulation Cart Improves Anesthesia Providers’ Confidence, Technical Skills, and Procedure Time."

The article is linked here.

Please answer the following two questions:

1. Do you feel like you had adequate training to perform a cricothyrotomy in anesthesia school? Are you confident in your skills to preform a cricothyrotomy, if needed? In this article, what improved anesthesia providers cricothyrotomy technical skills?


2. Have you ever had a patient that required a cricothyrotomy? If so, who performed the cricothyrotomy?

[Katya]

1.I don't think we had enough training in school for cricothyrotomy. Even we had several stimulation to do it at JH, I would not fill confident to do it myself. I never cut anybody alive with scalpel. i would leave it to doctors, surgeons preferably.
2. I had a patient once that required cricothyrotomy emergently during ENT case and it was done by ENT surgeon.

[Anne McNulty CRNA]

(1) I have never done a cricothyrotomy. I have had 2 training sessions in an airway lab for this. I would leave this to be done by the most experienced ent surgeon. (2) I have had a massive aspiration on induction that was close to emergency cricothyrotomy but managed to avoid by intubation with the cmac. The anesthesia providers in the study improved their performance by watching video and handling the airway equipment before taking part in the simulation. This would be a great project for SRNA students. I am in a room in JHOC . The cricothyrotomy equipment attached to the back of the anesthesia machine has an expiration sticker on it from 9/21. We have not kept up with this issue in ACCM

[Lu Lin]

1. Do you feel like you had adequate training to perform a cricothyrotomy in anesthesia school? Are you confident in your skills to preform a cricothyrotomy, if needed? In this article, what improved anesthesia providers cricothyrotomy technical skills?
I don’t think I have enough training to perform cricothyrotomy from anesthesia school. I am not confident in my skill to perform one. This article is a good reference for providers.

2. Have you ever had a patient that required a cricothyrotomy? If so, who performed the cricothyrotomy?
I had pt need this procedure and perform by surgeon.

[Jennifer Hannon]

1.I think we had thorough training at BC for cricothyrotomy, but that was so long ago without any stress and real patient needing it urgently, that I don't feel confident performing myself. I would leave it to the DART team and experienced ENT.
2. I have never had a patient who needed one. I hope this statistic continues for most providers.

[Soo-Ok Kim]

1.Do you feel like you had adequate training to perform a cricothyrotomy in anesthesia school? Are you confident in your skills to preform a cricothyrotomy, if needed? In this article, what improved anesthesia providers cricothyrotomy technical skills?
Even though I had training for this procedure, it was remote. I am not confident in my skills to perform a cricothyrodotomy especially during emergency. I would optimize all airway equipment including videolaryngoscope and most experienced staff to prepare for the case before getting to that point.


2. Have you ever had a patient that required a cricothyrotomy? If so, who performed the cricothyrotomy?
I had one pt requiring emergent cricothyroidotomy during level 2 ENT case around 11pm when tumor obstructed the airway view. ENT surgeon did it without hesitation successfully. Pt did well.

[Dahlia Rouchon]

Thank you for this helpful article.
1. I do not think I had adequate training to perform a cricothyrotomy before. We did not have a sim. lab with this hands on practice but learned about it in literature. I am not confident in my skills to perform one if needed.
Hands on practice of equipment and simuluation improved technical skills.
2. I have not had a patient require a cricothyrotomy before.

[BelindaG]

I do not feel like I have adequate training to perform cricothyrotomy despite some labs and occasional trainings throughout the years but this is something we should have annual training/ hands on practice with routinely if the expectation if for us to be facile at this procedure. From a safety standpoint this would be best done by an ENT surgeon but a good skill to have as a back up for us as airway providers!

All have been performed by ENT surgeons in cases I have been involved with.

[aileenm4]

1. I dont think we received enough training in this in my anesthesia school because it was so long ago as well! I think a sim session every few months would be great. I do a pediatric airway course whereI teach cricothyrotomy and needle cric with one of our peds ENT surgeons and it is super helpful.
I have never needed to do my own, but I have had patients needing crics when I worked at STC and the trauma surgeons did them at the bed side in the TRU

[cvelard1]

1. I have tried a cricothyrotomy on a manikin many years ago . Not proficient at all. I think constant reinforcement and muscle memory is necessary. There is no consistent course that enables us to practice .
2. I have not seen a patient need one in the past.

[sjsimmons]

1. Despite recently graduating, I do not feel like we got adequate training to perform a cricothyrotomy. During one simulation lab in anesthesia school, we practiced performing a cricothyrotomy on a pig larynx. Although this simulation allowed us to improve our cricothyrotomy technical skills, these skills were quickly forgotten due to lack of consistent practice. If faced with a can’t ventilate, can’t intubate scenario, I would not feel confident in my skills to perform a cricothyrotomy.

This article addresses the issue that anesthesia providers often have little experience performing a cricothyrotomy, which can lead to life-saving ventilation. I agree that implementation of a mobile cricothyrotomy simulation cart with a cricothyrotomy task-trainer manikin would greatly improve staff technical skills and confidence.

2. Although I have never had a patient that required a cricothyrotomy, I witnessed this scenario in the last few months of my training. The ENT surgeon ultimately performed the cricothyrotomy, but it took several attempts to successfully cannulate the trachea. With consistent cricothyrotomy training, I believe providers would feel more confident in their technical skills which may ultimately improve patient outcomes.