Ben-Haddour Mathieu, Colas Mathilde, Lefevre-Scelles Antoine, Durand Zoé, Gillibert André, Roussel Mélanie, Joly Luc-Marie
From the Departments of Emergency Medicine (M.B.H., Z.D., M.R., L.-M.J.) and Emergency Medicine-SAMU 76A (M.B.H., A.L.-S.), Rouen University Hospital, F-76000 Rouen; Department of Emergency Medicine-SAMU 76B (M.C.), Le Havre Hospital, F-76600 Le Havre; Departments of Anesthesiology and Critical Care (A.L.-S.) and Biostatistics (A.G.), Rouen University Hospital; and Normandy University UNIROUEN (L.-M.J., M.R.), F-76000 Rouen, France.
Simul Healthc. 2022 Jun 1;17(3):156-162. doi: 10.1097/SIH.0000000000000603. Epub 2021 Aug 13.
Emergency endotracheal intubation (ETI) is a high-risk procedure. Some of its adverse events are life-threatening, and guidelines emphasize the need to anticipate complications by thorough preparation. The emergency department (ED) can be an unpredictable environment, and we tested the hypothesis that a cognitive aid would help the emergency practitioners better follow guidelines. The main objective of this study was to determine whether the use of a cognitive aid focusing on both preintubation and postintubation items could improve ETI preparation and implementation in the ED resuscitation room regarding adherence to guidelines. The secondary objective was to measure and describe procedure times.
We conducted a single-blind randomized controlled trial with manikin-based in situ simulation. The participants were not aware of the purpose of the study. The cognitive aid was developed using national guidelines and current scientific literature. The most relevant items were the preparation and implementation of a rapid sequence induction for ETI followed by mechanical ventilation. Emergency department physician-nurse pairs were randomized into a "cognitive aid" group and a "control" group. All pairs completed the same scenario that led to ETI in their own resuscitation room. An adherence to guidelines score of 30, derived from the 30 items of the cognitive aid (1 point per item), and preparation and intubation times were collected.
Seventeen pairs were included in each group. Adherence to guidelines scores were significantly higher in the cognitive aid group than in the control group (median = 28 of 30, interquartile range = 25-28, vs. median = 24 of 30, interquartile range = 21-26, respectively, P < 0.01). Preparation, intubation, and total procedure times were slightly longer in the cognitive aid group, but these results were not significant.
In an in situ simulation, a cognitive aid for the preparation and implementation of an emergency intubation procedure in the ED resuscitation room significantly improved adherence to guidelines without increasing procedure times. Further work is needed in a larger sample and in different settings to evaluate the optimal use of cognitive aids in critical situations.
紧急气管插管（ETI）是一项高风险操作。其一些不良事件会危及生命，指南强调需通过充分准备来预见并发症。急诊科（ED）环境难以预测，我们检验了一种认知辅助工具能帮助急诊从业者更好地遵循指南这一假设。本研究的主要目的是确定使用聚焦于插管前和插管后项目的认知辅助工具能否改善急诊科复苏室中紧急气管插管的准备和实施情况，以使其更符合指南。次要目的是测量并描述操作时间。
我们进行了一项基于人体模型的现场模拟单盲随机对照试验。参与者并不知晓研究目的。认知辅助工具是依据国家指南和当前科学文献开发的。最相关的项目是为紧急气管插管进行快速顺序诱导并随后进行机械通气的准备和实施。急诊科医生 - 护士对被随机分为“认知辅助工具”组和“对照组”。所有对子在各自的复苏室完成相同的导致紧急气管插管的场景。收集源自认知辅助工具30项内容（每项1分）的指南遵循评分以及准备和插管时间。
每组纳入17对。认知辅助工具组的指南遵循评分显著高于对照组（中位数分别为30项中的28项，四分位间距 = 25 - 28，对比对照组中位数为30项中的24项，四分位间距 = 21 - 26，P < 0.01）。认知辅助工具组的准备、插管及总操作时间稍长，但这些结果不显著。
在现场模拟中，用于急诊科复苏室紧急插管操作准备和实施的认知辅助工具显著提高了对指南的遵循程度，且未增加操作时间。需要在更大样本和不同环境中开展进一步研究，以评估认知辅助工具在危急情况下的最佳使用方式。
