TY - JOUR

T1 - Flexible bronchoscopic intubation through a supraglottic airway device

T2 - An evaluation of consultant anaesthetist performance

AU - Svendsen, Christine N.

AU - Glargaard, Gine L.

AU - Lundstrøm, Lars H.

AU - Rosenstock, Charlotte V.

AU - Haug, Anne C.

AU - Afshari, Arash

AU - Hesselfeldt, Rasmus

AU - Strøm, Camilla

N1 - Publisher Copyright: © 2023 Acta Anaesthesiologica Scandinavica Foundation.

PY - 2024

Y1 - 2024

N2 - Background: Few clinical studies investigate technical skill performance in experienced clinicians. Methods: We undertook a prospective observational study evaluating procedural skill competence in consultant anaesthetists who performed flexible bronchoscopic intubation (FBI) under continuous ventilation through a second-generation supraglottic airway device (SAD). Airway management was recorded on video and performance evaluated independently by three external assessors. We included 100 adult patients undergoing airway management by 25 anaesthetist specialists, each performing four intubations. We used an Objective Structured Assessment of Technical Skills-inspired global rating scale as primary outcome. Further, we assessed the overall pass rate (proportion of cases where the average of assessors' evaluation for every domain scored ≥3); the progression in the global rating scale score; time to intubation; self-reported procedural confidence; and pass rate from the first to the fourth airway procedure. Results: Overall median global rating scale score was 29.7 (interquartile range 26.0–32.7 [range 16.7–37.7]. At least one global rating scale domain was deemed ‘not competent’ (one or more domains in the evaluation was scored <3) in 30% of cases of airway management, thus the pass rate was 70% (95% CI 60%–78%). After adjusting for multiple testing, we found a statistically significant difference between the first and fourth case of airway management regarding time to intubation (p =.006), but no difference in global rating scale score (p =.018); self-reported confidence before the procedure (p =.014); or pass rate (p =.109). Conclusion: Consultant anaesthetists had a median global rating scale score of 29.7 when using a SAD as conduit for FBI. However, despite reporting high procedural confidence, at least one global rating scale domain was deemed ‘not competent’ in 30% of cases, which indicates a clear potential for improvement of skill competence among professionals.

AB - Background: Few clinical studies investigate technical skill performance in experienced clinicians. Methods: We undertook a prospective observational study evaluating procedural skill competence in consultant anaesthetists who performed flexible bronchoscopic intubation (FBI) under continuous ventilation through a second-generation supraglottic airway device (SAD). Airway management was recorded on video and performance evaluated independently by three external assessors. We included 100 adult patients undergoing airway management by 25 anaesthetist specialists, each performing four intubations. We used an Objective Structured Assessment of Technical Skills-inspired global rating scale as primary outcome. Further, we assessed the overall pass rate (proportion of cases where the average of assessors' evaluation for every domain scored ≥3); the progression in the global rating scale score; time to intubation; self-reported procedural confidence; and pass rate from the first to the fourth airway procedure. Results: Overall median global rating scale score was 29.7 (interquartile range 26.0–32.7 [range 16.7–37.7]. At least one global rating scale domain was deemed ‘not competent’ (one or more domains in the evaluation was scored <3) in 30% of cases of airway management, thus the pass rate was 70% (95% CI 60%–78%). After adjusting for multiple testing, we found a statistically significant difference between the first and fourth case of airway management regarding time to intubation (p =.006), but no difference in global rating scale score (p =.018); self-reported confidence before the procedure (p =.014); or pass rate (p =.109). Conclusion: Consultant anaesthetists had a median global rating scale score of 29.7 when using a SAD as conduit for FBI. However, despite reporting high procedural confidence, at least one global rating scale domain was deemed ‘not competent’ in 30% of cases, which indicates a clear potential for improvement of skill competence among professionals.

KW - airway management

KW - bronchoscope

KW - clinical competence

KW - laryngeal mask airway

U2 - 10.1111/aas.14348

DO - 10.1111/aas.14348

M3 - Journal article

C2 - 37877551

AN - SCOPUS:85174620669

VL - 68

SP - 178

EP - 187

JO - Acta Anaesthesiologica Scandinavica

JF - Acta Anaesthesiologica Scandinavica

SN - 0001-5172

IS - 2

ER -