(1539) Tools, Techniques, and Teaching for Emergency Cricothyrotomy: A Scoping Review

Introduction: Emergency cricothyroidotomy (EC) is the final option in all failed airway algorithms. Evidence indicates clinicians lack formal training and experience in performing this lifesaving skill. We conducted a scoping review to identify evidence-based practices for teaching EC.

Methods: PubMed, Embase and Web of Science were searched from inception to January 2023 for pertinent studies. Inclusion criteria included manikin, animal, and cadaveric studies that evaluated the impact of an educational intervention for teaching EC on learning outcomes. There were no restrictions regarding the background of clinicians learning the procedure. Full-text articles were screened by pairs of reviewers and data extracted regarding study characteristics including study design, procedural technique, instructional approach and tools, didactic duration, extent of practice, and methods of assessment.

Results: In total, 11,960 unique references were identified; 195 full text articles were retrieved; and 82 studies were included. Thirty-two (39.0%) were randomized control trials, 17 (20.7%) were training or model evaluations, 16 (19.5%) had pre/post study design, and 17 (20.7%) had other study designs. Forty-four (53.7%) used manikins alone for training, 10 (12.2%) human cadavers alone, 10 (12.2%) animal models alone, 13 (15.9%) more than one type of model, and 5 (6.1%) used other modalities such as virtual reality. Forty-one (50.0%) of the studies taught a scalpel-based approach, 26 (31.7%) a needle-based approach, 13 (15.8%) both techniques, and 2 (2.4%) did not specify. Twenty-six (31.7%) reported didactic duration and 29 (35.4%) information on the extent of learner practice. Eighteen (22.0%) included time elapse between learning and assessment ranging from 24 hours to 12 months. Outcome measures of learning included attitudes (e.g., degree of satisfaction and confidence), knowledge (e.g., performance on multiple-choice assessment), or practice (e.g., time to ventilation or checklist score).

Conclusions: Our scoping review illustrates a diverse range of approaches for teaching and assessment of learning outcomes for EC. This scoping review may guide medical educators tasked with the organization and design of programs for teaching EC. In addition, it identifies a large research gap for future studies to focus upon.