Emergent Cricothyrotomy: Multiple Professions Feedback on Challenges of Maintaining Competency

Abstract

Background: In critical cannot intubate cannot oxygenate situations, cricothyrotomies are an option for an emergent airway; however, many people practice for years without performing or assisting with one. This survey set out to discover what equipment and education would enable familiarity and competency with performing/assisting with this procedure based on experience.

Methods: Interior Health comprises community to tertiary hospitals. 62 individuals within IH responded to an 18-question survey: 3% anesthesia assistant (AA), 7% anesthesiologist, 24% emergency physician, 2% ENT physician, 14% internist/intensivist, and 50% RT. Representation was from a wide spectrum of career experience: 15% 0-2 years, 11% 3-5 years, 36% 6-10 years, 19% 11-20 years, and 19% greater than 20 years. IH Privacy Impact department and ARECCI IRB approved this survey.

Results: 75% of the physicians, RTs, and AAs felt that scalpel bougie procedure is the easiest method of performing a cricothyrotomy to maintain competency. Currently only 70% of RTs and AAs agree or strongly agree they are familiar with their role during an emergent cricothyrotomy and 53% agree or strongly agree they are competent assisting. 65% of all participants stated that their workplace had more than one type of emergent cricothyrotomy kit and 30% strongly disagreed, disagreed, or were neutral to being familiar with emergent cricothyrotomy equipment at their hospital. 69% of participants were agreeable to having only one emergent cricothyrotomy procedure and set of equipment even if this meant it was not their preferred method. 61% of participants have never performed or assisted with an emergent cricothyrotomy. 52% of participants would like hands-on cricothyrotomy education simulations every year.

Conclusions: Standardization of equipment and procedure may improve competency but there is some initial opposition to this option. Best success for positive patient outcomes as well as ease of performing and assisting is by using the scalpel bougie method. Yearly hands-on education is desired for familiarity and competency with the cricothyrotomy procedure as this study revealed that many participants of this survey have not yet had to perform/assist with this skill throughout their career, and those that have, have done so quite infrequently. This provides us with an opportunity to develop multidisciplinary education/simulation days to support overall success for both patients and the professionals involved in emergent cricothyrotomies.