The Science Journal of the American Association for Respiratory Care

2006 OPEN FORUM Abstracts

Intubation and Difficult Airway Training With a VIRTUAL EDUCATION AND Simulation Technology Lab 

John S Emberger, BS, RRT; Francis A Gott, AS, RRT; Charles Fort, RN, MSN, Departments of Respiratory Care and Academic Affairs, Christiana Care Health System, Newark DE.

Background:  Respiratory Care Practitioners (RCPs) are the primary intubators at Christiana Care Health System facilities in code and emergent situations. RCP intubation certification includes an anesthesia rotation for insertion of both Endotracheal Tubes (ETT) and Laryngeal Mask Airways (LMA). The current study was designed to determine if a Virtual Education and Simulation Technology (VEST) lab session would improve the skills and knowledge of our RCPs in intubation and difficult airway management. 

Methods:
  We created a session of nine difficult airway scenarios in our VEST lab using a METI Human Patient Simulator.  An assessment of policy knowledge, technique and speed of inserting both ETTs and LMAs was performed before and after attending the VEST lab session.

Results:  Fourteen RCPs attended the VEST lab sessions. 

Assessment Item Pre-VEST Lab(M±SD) Post-VEST Lab(M±SD)
Complete knowledge of airway policy 57% 100%
LMA Confidence Level Score1 3.4 ± 1.3 4.0 ± 1.1
LMA Technique Score2 3.4 ± 1.1 5.0 ± 0.0 *
Time To Place LMA (seconds) 47 ± 16 21 ± 8 *
ETT Confidence Level Score1 4.2 ± 0.9 4.4 ±0.7
ETT Technique Score2 5.0 ± 0.0 5.0 ± 0.0
Time To Place ETT (seconds) 31 ± 10 17 ± 7 *


1Confidence scale:  1 to 5, where 1 = not confident to 5 = very confident scored by RCP

2Technique scale: 1 to 5, where 1= poor to 5= excellent, based on procedure technique scored by preceptor.

* p < 0.05    (Standard paired t-test)

Conclusions:  The VEST lab session did improve knowledge of airway policy and may help RCPs respond appropriately to airway situations at our health system.  The VEST lab session did (statistically and clinically) improve technique and reduce time to place an LMA.  Confidence and technique of ETT placement were already high, but VEST lab training statistically significantly reduced time to place an ETT. VEST lab sessions can be a valuable part of maintaining or improving skills such as intubation and LMA placement. Future studies should evaluate how long these improvements are maintained, or at what intervals staff should attend VEST lab sessions.

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