Feasibility of Telementoring for Cricothyroidotomy in Critical Care Transport Team Members

Although endotracheal intubation is the cornerstone of advanced airway management, there are cases where surgical airway becomes the only alternative. Since the coronavirus disease 2019 pandemic, there has been increased telemedicine physician consultation, including in trauma and emergency care. The objective of this study is to reveal that telemedicine was a viable means of coaching a prehospital clinician through a simulated cricothyroidotomy.

Paramedic and registered nurse participants from a critical care transport team were observed performing surgical cricothyroidotomy on a task trainer during 2 separate quarterly airway skills assessments. During the control session, participants completed a bougie-assisted cricothyroidotomy with no assistance. During the intervention, session participants used a trauma surgeon through video conferencing as a procedural coach. Skill completion was timed, performance was rated using a global rating scale, and participants completed the National Aeronautics and Space Administration Task Load Index.

There were 15 participants with paired observations available for analysis. There was no significant difference in total task time between solo and telementored sessions (effect size -22.47 [-52.82 to 7.89], P = .13). There was no significant difference in overall global rating scale between solo and telementored sessions (difference -0.27 [-1.63 to 1.10], P = .68). There were no differences in overall task load (difference 3.93 [-1.20 to 9.07], P = .12) or in any of the individual task load components between the solo and telementored sessions.

Telementorship was not associated with changes in procedural performance, task load, or time to complete a surgical cricothyroidotomy in a critical care transport team.