Skill retention of advanced airway techniques after simulation training - a randomized prospective study

Airway management is an essential component of patient care for anaesthesiologists and emergency medical services. When conventional techniques fail and a 'can't intubate, can't oxygenate' situation occurs, the front of neck access (FONA) is the last option to restore the patient's oxygenation. Therefore, learning and maintaining this skill is crucial for all healthcare professionals working in acute care including airway management. Nevertheless, training is time-consuming and task-trainers are expensive to maintain. A low-cost, self-made model has been described previously. The aim of this study was to determine whether the skill retention of the FONA procedure after three months is non-inferior when training is carried out on a self-made model compared to a high-fidelity manikin.

This study was designed as a randomized prospective trial conducted in a single tertiary care hospital, based on two groups (A and B), each consisting of 22 anaesthesiology residents. Group A trained on a self-made model according to the instructions of Varaday et al., while group B trained on a commercially available cricothyrotomy model (SimMan^® 3G, Laerdal Medical, Norway). The skill retention after three months was analysed by a FONA checklist and the time to first successful ventilation.

A total of 44 participants were included in the study, however, three of them dropped out before the final evaluation. The observed mean difference of -0.56 points in the achieved FONA score between the two training models fell within the predefined margin, demonstrating the non-inferiority of the self-made model. The mean difference in the duration of the FONA procedure after three month was + 3.6 s for the self-made model compared to the conventional training model.

The results confirm that FONA skill training using a self-made model is non-inferior to training on a full-scale simulator with respect to 3-month skill retention. These findings suggest that short and simple training sessions can be effectively conducted using an easily accessible, low-cost model, even in institutions without access to a full-scale simulator.

The trial was registered at clinicaltrials.gov on 13^th November 2024 (NCT06687395).