(S-185) JET VENTILATION FOR FAILED INTUBATION AND VENTILATION: AN ANALYSIS OF ANESTHESIOLOGISTS' PRACTICE USING A FULL- SCALE SIMULATOR

(S-185) Steadman, R.H., Saturday 9:15

TITLE: JET VENTILATION FOR FAILED INTUBATION AND VENTILATION: AN ANALYSIS OF ANESTHESIOLOGISTS' PRACTICE USING A FULL- SCALE SIMULATOR

AUTHORS: Randolph H. Steadman, MD¹, Ryan A. Crowley¹, Steve C. Yun, MD¹, Deep Bhasin, MD², Phil Levin, MD¹, Rima Matevosian, MD³, Tom Nguyen, MD²AFFILIATION: ¹UCLA, Los Angeles, CA; ²USC, Los Angeles, CA; ³Olive View Medical Center, Sylmar, CA.

INTRODUCTION: As experts in airway management, ane- sthesiologists are expected to establish a transtracheal airway in the event that other, more routine methods fail. Full-scale simulation provides a standardized and realistic environment in which to evaluate whether anesthesiologists are adequately prepared to perform this maneuver.
METHODS: From a videotape archive of critical incident simulations involving fully trained anesthesiologists, a failed rapid sequence induction scenario was selected for review (n=12). During the standardized scenario (planned events unknown to participants), the simulator was configured so that the participants were unable to intubate, ventilate, or oxygenate unless a transtracheal airway was established.
RESULTS: All participants ultimately performed a needle cricothyrotomy followed by transtracheal jet ventilation (TTJV). None of the participants performed an incisional cricothyrotomy. Observed errors in transtracheal airway technique are sum- marized below (participants may have committed more than one error).

Errors with injury potential (barotrauma)	9/12
Initiated TTJV with a misplaced catheter	3/12
Catheter placement not confirmed prior to TTJV	6/12
Needle not removed from catheter prior to TTJV	2/12
Failed to maintain catheter position	2/12
Errors resulting in inadequate oxygenation*	8/12
Attempted TTJV through breathing circuit1	4/12
Failure to recognize inadequate TTJV	4/12
Transtracheal catheter directed cephalad	1/12
Participants making any of the above errors	12/12

*Excludes TTJV with a misplaced catheter as noted above.

CONCLUSION: While all participants demonstrated a conceptual understanding of the ASA Difficult Airway Algorithm² by recognizing the need for a transtracheal airway, subjects uniformly encountered difficulties during implementation of TTJV. Full-scale simulation may create a valuable environment to assess and teach airway management skills since it requires participants to make decisions and perform appropriate procedures in a timely fashion.
REFERENCES:

1.) Benumof et al. Anesthesiology 1989; 71: 769-78.

2.) Caplan et al. Anesthesiology 1993; 78: 597-602.