Performance Assessment in Airway Management Training for Nonanesthesiology Trainees

Thomas E. Grissom, Joshua Sappenfield, Samuel M. Galvagno, Shane V. Cherry, Yu-Cherng Channing Chang, Peter F. Hu
2014 Anesthesiology  
A LTHOUGH the ability to evaluate and effectively manage a wide-range of airway conditions is the defining skill of an anesthesiologist, other physicians with acute care responsibilities are expected to be competent in airway management. The question then arises as to the best means of training the nonanesthesiologist to manage the airway in both the stable and unstable patient during their residency training program. The means for providing airway management training to nonanesthesiologists
more » ... taken multiple approaches. Many residencies have established formal training programs utilizing simulation-, cadaveric-, and/or didactic-based formats combined with "on the job" clinical experience. 1-4 Unfortunately, there are still barriers to training and it is often difficult to achieve a sufficient volume of clinical cases to establish competency during rotations in the primary specialty. 5 Many of these programs have reached out beyond their specialty to associated anesthesiology departments for additional training and clinical experience. The operating room (OR) has always been considered an ideal location for clinical training in airway management. Given the large volume of procedures, varied patient population, stable conditions for teaching and availability of highly trained staff, many residency training programs have established rotations in the OR for training in airway What We Already Know about This Topic • Little is known regarding the utility and outcomes of brief training rotations on airway management by anesthesiologists for those outside the specialty What This Article Tells Us That Is New • In a study of approximately 100 trainees undergoing a 4-week rotation, with over 4,200 airway procedures, first-attempt success at endotracheal intubation increased as a function of rotation week, as did self-reported laryngoscopic view ABSTRACT Background: Although the use of an anesthesiology "airway" rotation to train the nonanesthesiologist is commonly employed, little data exist on the utility, clinical exposure, and outcomes of these programs. Methods: A prospectively collected observational dataset of airway procedures completed by trainees in a 4-week, anesthesiology-based, airway rotation at an academic, level-1 trauma center from July 2010 to September 2012 was reviewed. Prospectively defined data points were collected through an online data tool and included patient demographics, location, date, best laryngoscopic view, and attempt details. At the authors' institution, an attending trauma anesthesiologist is present for all intubation attempts. The primary outcome was first-attempt success. Results: A total of 4,282 self-reported, airway procedures were identified. The median number of procedures performed was 50.4 ± 13.2 (range, 20 to 93; 25th quartile = 41; 75th quartile = 57). Multivariate logistic regression analysis modeling of firstattempt success rate identified two independent predictors of success: rotation week (odds ratio, 1.42; 95% CI, 1.32 to 1.61; P < 0.0001) and number of previous intubation attempts before rotation (odds ratio, 1.23; 95% CI, 1.03 to 1.46; P = 0.02. In addition, the percentage of cases with a self-reported laryngoscopic grade 1 view increased significantly from 61 to 74% (P = 0.015) from week 1 to week 4 of the rotation. Conclusions: An anesthesiology-based program for airway training of nonanesthesiologists demonstrates improved self-reported, perceived first-attempt success over the course of training with improved ability to visualize glottic structures. (Anesthesiology 2014; 120:185-95)
doi:10.1097/aln.0000000000000064 pmid:24201030 fatcat:skmgok2w5vbh5jf5sjjzf3cwvu