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simulation
technology
teaching methods

Safe transfer of simulation-based intubation skills to patients in cardiac arrest

02 March 2018
Features
02 March 2018
Volume 10 · Issue 3

Abstract

Background:

Studies investigating the transfer of endotracheal intubation skills from simulation training to out-of-hospital patient scenarios are limited.

Aims:

The aim was to evaluate the outcome of endotracheal intubation simulation training among paramedics and the safe transfer of skills to out-of-hospital cardiac arrest (OHCA) patients.

Methods:

Paramedics participated in a 1-day simulation training course including five Airtraq endotracheal intubation attempts using three different types of mannequins (n=15 attempts). Performance and outcome of transfer of intubation skills to patients were monitored for the next 35 months. European Resuscitation Council international advanced cardiopulmonary resuscitation guidelines (Nolan et al, 2005) were followed to ensure patient safety.

Findings:

Endotracheal intubation was attempted in a total of 417 patients with OHCA by 51 (96%) of the 53 participating paramedics. In 366 (88%) patients, intubation was successfully performed in the first or second attempt. Aspiration, airway secretion, a high modified Cormack Lehane score and insecure verification of tube placement were the most common reasons for failed intubation.

Conclusion:

Endotracheal intubation with Airtraq in adult patients with OHCA can be performed safely by paramedics after receiving a 1-day simulation-based training course.

Endotracheal intubation is a complex psychomotor skill, that is potentially harmful to the patient when performed by an inexperienced operator. During the past decades, attention has been focused on acquiring technical and surgical skills in safe simulation-based training environments. In addition, emphasis has been placed on transferring skills to clinical practice, such as the pre-hospital setting (Stratton et al, 1991; Owen and Plummer, 2002).

Several factors affect the transfer of skills in endotracheal intubation, such as:

Few studies have tried to identify the most effective training method in endotracheal intubation skills and the transfer of these skills to patients in clinical practice (Stewart et al, 1984; Stratton et al, 1991; Naik et al, 2001).

Pre-hospital endotracheal intubation is performed by paramedics in countries such as the UK (Lyon et al, 2010; Branding et al, 2016), and the United States (US) (Stewart et al, 1984; Stratton et al, 1991; Myers et al, 2016; Ducharme et al, 2017). In Denmark, endotracheal intubation is performed by a pre-hospital anaesthesiologist. At the time of the current study, only one anaesthesiologist-based mobile emergency care unit covered the North Denmark Region, an area of 8000 km2 and 580 000 citizens (Region Nordjylland).

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Endotracheal intubation
Pre-hospital
Paramedics
Airtraq
Simulation
Transfer
Out-of-hospital cardiac arrest