Optimising remote site airway management kit dump using the SCRAM bag-a randomised controlled trial

Area of Science:

• Anesthesiology
• Emergency Medicine
• Patient Safety

Background:

• Remote emergency airway management is linked to higher morbidity and mortality.
• Inadequate equipment preparation and workflow interruptions contribute to adverse outcomes.
• The Structured CRitical Airway Management (SCRAM) bag was developed to standardize airway management preparation.

Purpose of the Study:

• To evaluate the effectiveness of the SCRAM bag in reducing equipment preparation time.
• To assess the impact of the SCRAM bag on error rates during airway management.
• To determine the effect of the SCRAM bag on operator cognitive load.

Main Methods:

• Fifty experienced anesthetists were randomized into two groups: SCRAM bag (n=25) and standard trolley (n=25).
• Participants prepared for and managed a simulated difficult airway scenario.
• Primary outcome: time to kit dump completion. Secondary outcomes: error count and self-reported difficulty.

Main Results:

• The SCRAM bag group showed a 29% reduction in kit dump time (111.7s vs 156.7s, p=0.0001).
• Participants using the SCRAM bag reported less difficulty (18.36mm vs 50.64mm, p<0.001).
• Significantly fewer errors occurred with the SCRAM bag (1 vs 8, p=0.03), an 87.5% reduction.

Conclusions:

• The SCRAM bag enables faster, less challenging preparation with fewer errors.
• This structured approach can decrease delays in airway management.
• The SCRAM bag enhances the ability to manage airway events, improving patient safety.