Department of Emergency Medicine, Division of EMS, East Carolina University Brody School of Medicine, Greenville, NC, United States.
Department of Emergency Medicine, Division of EMS, East Carolina University Brody School of Medicine, Greenville, NC, United States.
Am J Emerg Med. 2019 Mar;37(3):407-410. doi: 10.1016/j.ajem.2018.05.073. Epub 2018 May 31.
Cricothyrotomy may be necessary for airway management when a patient's airway cannot be maintained through standard techniques such as oral airway placement, blind insertion airway device, or endotracheal intubation. Wire-guided cricothyrotomy is one of many techniques used to perform a cricothyrotomy. Although there is some controversy over which cricothyrotomy technique is superior, there is no published data regarding long term retention rates. The purpose of this study is to determine whether ground based paramedics can be taught and are able to retain the skills necessary to successfully perform a wire-guided cricothyrotomy.
This retrospective study was performed in a suburban county with a population of 160,000 with 23,000 EMS calls per year. Participants were ground-based paramedics who were taught wire-guided cricothyrotomy as part of a standardized paramedic educational update program. After viewing an instructional video, the paramedics were shown each the steps of the procedure on a simulation model, using a low fidelity task trainer previously developed to train emergency medicine residents. Using a 16 step procedural checklist, participants were allowed open-ended practice using the task trainer. Critical steps in the checklist were marked in bold lettering indicating automatic failure. Each paramedic was then individually supervised performing a minimum of 5 successful simulations. Retention was assessed using the same 16 step checklist 6 to 12 weeks following the initial training.
A total of 55 paramedics completed both the initial training and reassessment during the time period studied. During the initial training phase 100% (55 of 55) of the paramedics were successful in performing all 16 steps of the wire-guided cricothyrotomy. During the retention phase, 87.3% (48 of 55) of paramedics retained the skills necessary to successfully perform the wire-guided cricothyrotomy. On the 16 step checklist, most steps were performed successfully by all the paramedics or missed by only 1 of the 55 paramedics. The step involving removal of the needle prior to advancing the airway device over the guide wire was missed by 34.5% (19 of 55) of the participants. This was not an automatic failure since most participants immediately self-corrected and completed the procedure successfully.
Paramedics can be taught and can retain the skills necessary to successfully perform a wire-guided cricothyrotomy on a simulator. Future research is necessary to determine if paramedics can successfully transfer these skills to real patients.
当患者的气道无法通过口腔气道放置、盲目插入气道装置或气管插管等标准技术维持时，可能需要进行环甲膜切开术来进行气道管理。导丝引导的环甲膜切开术是进行环甲膜切开术的众多技术之一。虽然哪种环甲膜切开术技术更优越存在争议，但尚无关于长期保留率的发表数据。本研究旨在确定地面基础护理人员是否可以接受培训并能够保留成功进行导丝引导的环甲膜切开术所需的技能。
这项回顾性研究在一个拥有 16 万人口的郊区县进行，每年有 23000 次 EMS 呼叫。参与者是接受导丝引导的环甲膜切开术培训的地面基础护理人员，这是标准化护理人员教育更新计划的一部分。观看教学视频后，护理人员在模拟模型上展示了该程序的每一步，使用先前开发的低保真度任务培训器来培训急诊医学住院医师。使用 16 步程序检查表，参与者可以使用任务培训器进行无限制的实践。检查表中的关键步骤用粗体字母标记，表示自动失败。然后，每位护理人员在单独监督下进行至少 5 次成功模拟。在初始培训后 6 至 12 周，使用相同的 16 步检查表评估保留情况。
在研究期间，共有 55 名护理人员完成了初始培训和重新评估。在初始培训阶段，100%（55 名中的 55 名）护理人员成功完成了导丝引导的环甲膜切开术的所有 16 个步骤。在保留阶段，87.3%（55 名中的 48 名）护理人员保留了成功进行导丝引导的环甲膜切开术所需的技能。在 16 步检查表上，大多数步骤都得到了所有护理人员的成功执行，或者只有 55 名护理人员中的 1 名遗漏了其中一个步骤。涉及在将气道装置推进导丝之前移除针的步骤被 34.5%（55 名中的 19 名）参与者遗漏。这不是自动失败，因为大多数参与者立即自行纠正并成功完成了该程序。
可以教授护理人员并保留在模拟器上成功进行导丝引导的环甲膜切开术所需的技能。需要进一步的研究来确定护理人员是否可以将这些技能成功转移到实际患者身上。
