Incomplete adherence to the ASA difficult airway algorithm is unchanged after a high-fidelity simulation session

Area of Science:

• Anesthesiology
• Medical Simulation
• Airway Management

Background:

• Published guidelines exist for difficult airway management.
• The adherence of consultant anesthesiologists to these guidelines in critical scenarios is not well-documented.

Purpose of the Study:

• To assess anesthesiologists' management of a simulated cannot intubate, cannot ventilate (CICV) scenario.
• To determine if simulation-based teaching improves adherence to the American Society of Anesthesiologists (ASA) difficult airway algorithm.

Main Methods:

• Consultant anesthesiologists managed a simulated CICV scenario in a high-fidelity simulator.
• Participants underwent a one-hour video-assisted debriefing and hands-on cricothyroidotomy training.
• A second identical CICV scenario was performed immediately after training.

Main Results:

• No significant reduction in major deviations from the ASA algorithm was observed post-simulation.
• Failure to call for surgical help increased in the second session (P=0.04).
• Times to initiate cricothyroidotomy and achieve ventilation were significantly reduced post-simulation (P=0.01 and P=0.0002, respectively).

Conclusions:

• A single simulation session did not substantially alter airway management in CICV scenarios.
• Personal clinical experience with airway devices may outweigh algorithmic guidance in emergency decision-making.