Fayed Mohamed, Nowak Katherine, Angappan Santhalakshmi, Patel Nimesh, Abdulkarim Fawaz, Penning Donald H, Chhina Anoop K
Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Health System, Detroit, USA.
Research, Henry Ford Health System, Detroit, USA.
Cureus. 2022 Mar 17;14(3):e23260. doi: 10.7759/cureus.23260. eCollection 2022 Mar.
Introduction One of the most challenging scenarios an anesthesia provider can face is treating a can't intubate can't ventilate (CICV) patient. The incidence of CICV is estimated to be around one in 10,000 cases. According to the American Society of Anesthesiology Closed Claims Study, adverse respiratory events are the most common type of injury, with difficult intubation and ventilation contributing to the majority of these cases. The objective of this non-interventional quality improvement project was to evaluate the prior training, exposure, and self-reported confidence in handling the CICV scenario among anesthesia providers at Henry Ford Hospital in Detroit, MI. Methods An online questionnaire was distributed via email to all residents, certified registered nurse anesthetists (CRNAs), and attending anesthesiologists in March 2021. The email contained a link to an online questionnaire via Microsoft Forms (Microsoft Corporation, Redmond, WA). Univariate group comparisons were carried out between the respondents' role (attending, CRNA, or resident), as well as between the number of years that the respondents were in practice (< 5 years, 5-10 years, > 10 years). Results Out of the total 170 anesthesia providers, 119 participated in the study where 54 (45%) were attendings, 44 (37%) were residents, and 21 (18%) were CRNAs. The majority (75%) did not know the surgical airway kit location, and 87% had not performed the surgical airway procedure before. The vast majority (96.7%) recommended simulation training compared to online training or lecture series, and just over 50% recommended annual training frequency. When looking at the differences in responses based on years of experience as an anesthesia provider, the majority of those with > 10 years in practice knew how to perform the surgical airway technique while respondents with < 5 years did not know how to perform the technique, and 50% of those with five to 10 years experience knew how to perform the surgical airway procedure for a CICV scenario. Conclusion Although there were many significant differences observed between the various provider roles and years in practice, surprisingly, the responses revealed both a lack of experience and confidence in performing the surgical airway procedure in all provider roles. These findings highlight a need for better emergency airway teaching and training. These findings will be used to guide the design and implementation of improved surgical airway training for residents, CRNAs, and attending anesthesiologists with the goal of better preparedness for handling a CICV scenario.
引言
麻醉医生可能面临的最具挑战性的情况之一是处理无法插管且无法通气（CICV）的患者。CICV的发生率估计约为万分之一。根据美国麻醉医师协会的封闭索赔研究，不良呼吸事件是最常见的伤害类型，其中大多数情况是由困难插管和通气导致的。这项非干预性质量改进项目的目的是评估密歇根州底特律亨利福特医院的麻醉医生在处理CICV情况方面的先前培训、经验以及自我报告的信心。
方法
2021年3月，通过电子邮件向所有住院医生、注册护士麻醉师（CRNA）和主治麻醉医生分发了一份在线问卷。电子邮件中包含一个通过Microsoft Forms（微软公司，华盛顿州雷德蒙德）指向在线问卷的链接。在受访者的角色（主治医生、CRNA或住院医生）之间以及受访者的执业年限（<5年、5 - 10年、>10年）之间进行单变量组比较。
结果
在总共170名麻醉医生中，119人参与了研究，其中54人（45%）是主治医生，44人（37%）是住院医生，21人（18%）是CRNA。大多数人（75%）不知道手术气道套件的位置，87%的人以前没有进行过手术气道操作。与在线培训或系列讲座相比，绝大多数人（96.7%）推荐模拟培训，略超过50%的人推荐每年进行培训。在查看基于麻醉医生经验年限的回答差异时，大多数执业超过10年的人知道如何进行手术气道技术操作，而执业年限<5年的受访者不知道如何进行该技术操作，50%有5至10年经验的人知道如何在CICV情况下进行手术气道操作。
结论
尽管在不同的医生角色和执业年限之间观察到了许多显著差异，但令人惊讶的是，回答显示所有医生角色在进行手术气道操作方面都缺乏经验和信心。这些发现凸显了对更好的紧急气道教学和培训的需求。这些发现将用于指导为住院医生、CRNA和主治麻醉医生设计和实施改进的手术气道培训，目标是为处理CICV情况做好更充分的准备。
