Testing airway management skills: interactive video courseware vs ACLS instructor

Lectures and demonstrations have been the teaching and testing strategies most often employed by the American Heart Association in Advanced Cardiac Life Support (ACLS) training. I compared the abilities of interactive videodisc (IVD) courseware and ACLS instructors to evaluate airway management skills.

Twenty-two subjects were simultaneously tested during 30 attempts at endotracheal (ET) intubation and 34 attempts at esophageal obturator airway or esophageal gastric tube airway (EOA/EGTA) insertion. The instructors were blind to the visual and auditory messages produced.

The IVD program and the ACLS instructors showed high agreement in their evaluation of student performance for time of intubation (95.5% ET; 100% EOA/EGTA), proper tube placement (91% ET; 93% EOA/EGTA), appropriate tube assessment (95.5% ET; 100% EOA/EGTA), and correct EOA/EGTA cuff inflation (100%). Lower levels of agreement were noted with ET and EOA/EGTA appropriate head positioning, and the evaluation of tooth pressure with ET intubation (60.5%, 76.5%, and 66.0%, respectively). The IVD system was unable to detect certain procedural errors associated with appropriate intubation procedure--syringe attachment, syringe removal after cuff inflation, and control of tube after intubation. The low agreement for tooth pressure suggests that the sensor-equipped manikin may better evaluate tooth pressure than does the observer.

Although the IVD system shows promise as an adjunct method for instruction and testing, it cannot be considered suitable for 'stand-alone' instruction. Further research is needed to explore costs, skills retention, and possible impact of the medium for training hospital and prehospital-care personnel.