: Management of obstetric airway emergencies: Assessing critical skills of anesthesia residents with high-fidelity simulation
Abstract Number: 167
Abstract Type: Original Research
Introduction: Airway catastrophe is challenging in an obstetric patient, as the lives of both the mother and the fetus may be compromised by such an event. Currently, there is no universally accepted algorithm nor consensus on basic management approaches for unanticipated difficult airway in the obstetric population. It is also unknown if anesthesia residents are competent enough to handle such emergencies. The objective of this project was to assess the knowledge and skills of senior anesthesia residents in the management of difficult airway in obstetric patients, and identify gaps in teaching based on the expected standard of care embodied by an algorithm proposed by a panel of experts.
Methods: Four scenarios of various types of airway emergencies in the presence of maternal and/or fetal instability, were created [CS in a case of maternal emergency alone (scenario 1), maternal and fetal emergency (scenario 2), fetal emergency alone (scenario 3), and no emergency (scenario 4)]. An airway algorithm was created based on previous guidelines using the Delphi technique. Senior anesthesia residents (PGY4-5) underwent simulations with a Laerdal SimMan® and a common team of trained actors playing the role of an obstetrician, nurse, and respiratory therapist, followed by a debriefing session. The residents’ technical and non-technical skills (Ottawa global rating scale [GRS]) were evaluated independently by 3 experts.
Results: 16 residents participated in 64 simulation scenarios. The evaluator and self rating scores for the technical skills are shown in Table 1. Self-rating scores were considerably lower than those of evaluators. Overall GRS scores were marginal. The tasks not performed by >50% participants include a) call for help, b) call for difficult airway cart, c) adequate oxygenation in “cannot ventilate” scenario, and d) consideration of definitive airway and post-delivery ICU transfer in the presence of maternal instability.
Discussion: This project has helped us determine common areas of errors and deficiencies in residents’ training, and establish effective teaching strategies and algorithm in the management of difficult airway in obstetric patients to reduce the likelihood of adverse outcomes. We suggest that further teaching and simulations addressing these deficiencies will improve residents’ ability towards managing such cases in real-life situations.
References: Anesthesiology 1993; 78: 597–602; Can J Anaesth 1998: 45: 757-76