Assessing resident skills in the use of rescue airway devices

Airway control is a vital procedure for the specialty of emergency medicine. Although endotracheal intubation is the preferred method to obtain a definitive airway, several devices have been developed to help physicians handle a difficult or failed intubation. Using a bench model, we assessed the efficacy of an advanced airway training program.

Residents of an Accreditation Council for Graduate Medical Education-accredited 3-year emergency medicine residency program participated in an advanced airway course. Psychomotor skills were assessed for the laryngeal mask airway, intubating laryngeal mask airway (Fastrac), and Combitube (esophageal-tracheal twin-lumen airway device). The outcome variable was the time necessary to successfully insert and ventilate an airway mannequin. The skills were assessed at 0, 6, and 12 months after training. Information including previous and interval experience with these devices was recorded.

The airway mannequin was successfully ventilated using the laryngeal mask airway, Fastrac, and Combitube in 6.9, 51.0, and 21.5 seconds, respectively. There was a modest interval increase in mean time required to place the laryngeal mask airway and Combitube at 6 and 12 months after training. A decrease was noted in the time to place the Fastrac. Previous and interval experience did not affect performance.

Airway competency is a key component of emergency medicine training. Training should include mastery of rescue devices for the failed or difficult airway. Our findings suggest that emergency medicine residents can learn and retain these airway skills.