[The mindset of anesthesiologists while performing surgical airway management]

The surgical establishment of a secure airway in a cannot intubate-cannot oxygenate situation represents a feared and multidimensionally challenging situation in anesthesiology and emergency medicine teams. Numerous factors can influence the performance of a cricothyroidotomy. In addition to experience, knowledge and practical skills, the materials used and the mindset of the personnel also appear to play a significant role.

This study aimed to provide a comprehensive picture of experiences, attitudes and knowledge on surgical airway management of medical personnel at a department of anesthesiology and intensive care medicine. This study builds on data collected on cricothyroidotomy in 2017, which changed the internal training concept adaptation of the hospital.

This study used a mixed qualitative and quantitative approach. We conducted a survey using questionnaires sent to all physicians of the department of anesthesiology, followed by expert interviews with doctors in training, specialists and senior physicians.

We could evaluate 59 questionnaires from the medical personnel. Additionally, we conducted 4 group interviews, each with 6-8 participants. We could demonstrate the significant influence of skill and simulation teaching programs on coniotomy; however, in the total collective the safety of decisions and performance remains low. Interviews covered a wide range of anesthesiological topics that indirectly affect and influence the topic of surgical airway management. The role of the anesthesia identification card was explained and the further education in the field of awake fiberoptic intubation was examined.

Cricothyroidotomy in the context of failed airway management is and remains one of the most challenging scenarios for anesthesiology teams. Regular continuing education in the form of skills training, followed by integration into simulation scenarios, can significantly increase the subjective competence; however, the well-known uncertainty about an objectively measurable or detectable point that unequivocally indicates a cricothyroidotomy remains an inhibiting factor that needs to be addressed in the further development of training programs.