PMID- 37032668
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20231031
IS  - 1658-354X (Print)
IS  - 0975-3125 (Electronic)
VI  - 17
IP  - 1
DP  - 2023 Jan-Mar
TI  - Simulating high-fidelity emergency front-of-neck access: Training in an obstetric 
      setting.
PG  - 12-17
LID - 10.4103/sja.sja_494_22 [doi]
AB  - INTRODUCTION: In a cannot intubate, cannot oxygenate scenario (CICO), emergency 
      front of neck access (eFONA) is the final lifesaving step in airway management to 
      reverse hypoxia and prevent progression to brain injury, cardiac arrest and 
      death. The Difficult Airway Society (DAS) guidelines advise the scalpel 
      cricothyroidotomy method for eFONA. Anatomical and physiological changes in 
      pregnancy exacerbate the already challenging obstetric airway. We aim to assess 
      the impact made by introducing formal eFONA training to the perioperative 
      medicine department of an obstetric hospital. METHODS: Ethical approval and 
      written informed consent were obtained. 17 anesthetists participated, (two 
      consultants, one senior registrar, four registrars and eight senior house 
      officers). Study design was as follows: Initial participant survey and 
      performance of a timed scalpel cricothyroidotomy on Limbs & Things AirSim Advance 
      X cricothyroidotomy training mannikin. Difficulty of the attempt was rated on a 
      Visual Analogue Scale (VAS). Participants then watched the DAS eFONA training 
      video. They then re-performed a scalpel cricothyroidotomy and completed a repeat 
      survey. The primary endpoint was duration of cricothyroidotomy attempt, measured 
      as time from CICO declaration to lung inflation confirmed visually. After a 
      three-month period, participants were reassessed. RESULTS: Four anesthetists had 
      previous eFONA training with simulation, only one underwent training in the 
      previous year. The mean time-to-lung inflation pre-intervention was 123.6 seconds 
      and post-intervention was 80.8 seconds. This was statistically significant (p = 
      0.0192). All participants found training beneficial. Mean improvement of VAS was 
      3. All participants' confidence levels in identifying when to perform eFONA and 
      ability to correctly identify anatomy improved. On repeat assessment, 11/13 
      participants successfully performed a surgical cricothyroidotomy, mean 
      improvement from first attempt was 12 seconds (p = 0.68) which was not 
      statistically significant. CONCLUSION: This method of training is an easily 
      reproducible way to teach a rarely performed skill in the obstetric population.
CI  - Copyright: (c) 2023 Saudi Journal of Anesthesia.
FAU - O'Sullivan, Mai
AU  - O'Sullivan M
AD  - University Hospital Galway, Galway, Ireland.
FAU - Gaffney, Sarah
AU  - Gaffney S
AD  - Saint James's Hospital, Dublin, Ireland.
FAU - Free, Ross
AU  - Free R
AD  - Coombe Womens and Infants University Hospital, Dublin, Ireland.
FAU - Smith, Stephen
AU  - Smith S
AD  - Coombe Womens and Infants University Hospital, Dublin, Ireland.
LA  - eng
PT  - Journal Article
DEP - 20230102
PL  - India
TA  - Saudi J Anaesth
JT  - Saudi journal of anaesthesia
JID - 101500601
PMC - PMC10077770
OTO - NOTNLM
OT  - Airway
OT  - eFONA
OT  - obstetric
COIS- There are no conflicts of interest.
EDAT- 2023/04/11 06:00
MHDA- 2023/04/11 06:01
PMCR- 2023/01/01
CRDT- 2023/04/10 03:44
PHST- 2022/07/05 00:00 [received]
PHST- 2022/07/13 00:00 [accepted]
PHST- 2023/04/11 06:01 [medline]
PHST- 2023/04/10 03:44 [entrez]
PHST- 2023/04/11 06:00 [pubmed]
PHST- 2023/01/01 00:00 [pmc-release]
AID - SJA-17-12 [pii]
AID - 10.4103/sja.sja_494_22 [doi]
PST - ppublish
SO  - Saudi J Anaesth. 2023 Jan-Mar;17(1):12-17. doi: 10.4103/sja.sja_494_22. Epub 2023 
      Jan 2.