Emergency Surgical Front-of-Neck Airway Access: Effectiveness of a Didactic and Simulation-Based Training Intervention to Improve Performance and Self-Efficacy Among Resident Registered Nurse Anesthetists

Simulation is a valuable tool for developing technical skills and self-efficacy for high-risk, low-frequency events such as cannot intubate, cannot oxygenate (CICO) scenario. There is a deficiency of evidence regarding CICO events and emergency front of neck access training for resident registered nurse anesthetists (RRNAs). This study explored whether a low-fidelity simulation training utilizing a 3D-printed cricothyrotomy task trainer and educational intervention increased self-efficacy, improved performance measures (performance time, performance checklist scores), and increased expert performance levels (performance time, performance checklist score, completion of critical performance checklist steps) regarding scalpel-bougie-tube surgical cricothyrotomy (SBT-SC) among RRNAs. This pilot study utilized a quasiexperimental pretest-posttest design. Ten RRNAs participated in the study. Statistical analysis with paired t-tests demonstrated statistically significant improvement in mean self-efficacy scores (3.13 to 4.5 out of 5, P < .001), mean performance completion time (103.5 seconds (SD, 34.5) to 55.9 (SD, 17.9) seconds [P < .001]), mean performance checklist scores (5.5 to 9.1 out of 10, [P < .001]), and completion of critical checklist steps. Six participants completed the postintervention SBT-SC in under 60 seconds while completing all critical checklist steps. One participant met expert performance benchmark criteria following the intervention. This study supports low-fidelity simulation for SBT-SC education and training for RRNAs.