Impact of simulation training in a clinical emergency: A simulation based randomized controlled trial on difficult airway management of a “can’t intubate can’t ventilate” case scenario at SIM Center Kigali Teaching Hospital, Rwanda

Abstract

Background: The effectiveness of simulation is rarely evaluated in Africa. The aim of this study was to assess the impact of a short training course on the ability of anesthesiology and emergency medicine residents, and non-physician anesthetists to comply with vortex approach tool for difficult airway management immediately after training. Methods: Forty participants comprising anesthesiology and, emergency medicine residents, and non-physician anesthetist were assessed on simulation in a “can’t intubate, can’t ventilate” scenario after the training randomization into control group (use memory only) and intervention group (use cognitive aid). The scenario was built so that the participant was prompted to perform External Surgical Airway. Adherence with airway management guideline (grading checklist 0 to 14) and the External Surgical Airway’ duration and Anesthesia Non-Technical Shills (0 to 4) were assessed as a checklist score. Results: After training, all 40 participants (100%), the performance between control and intervention were good in the intervention group, the mean grading checklist score (0 to 14) was 10 (P 0.046) in the intervention group and 7 in the control group, the mean time to attempt ESA (0 to 8) was 165s in the intervention group and 183s in the control group, the mean score adherence to cognitive aid was 12.6 (90%) in the intervention group, in the control group was 6.3 (60%). The group with access to the cognitive aid had higher scores in all categories (Grading checklist and ANTS), there was a trend towards a higher proportion of the participants in the cognitive aid group being able to oxygenate within 3 min of entering the room. Conclusion: The use of cognitive aid improved the participants’ adherence to the protocol and their performance for time to attempt External Surgical Airway and Anesthesia Non-Technical Skills are improved when a cognitive aid is present during airway emergencies