(1079) Introduction to Advanced Airway Management Curriculum for IM Residents

Introduction: Advanced airway management (AAM) is an essential skill in critical care medicine. The adoption of algorithmic approach and Rapid Sequence Intubation (RSI) have demonstrated improved first-pass success rate and reduced post-intubation complications. With this information, most training programs in anesthesiology, emergency medicine, and critical care medicine have adopted standardized AAM training curriculum. However, AAM training for Internal Medicine (IM) residents seems to be variable and institution dependent. At our institution, IM residents received no formal training in AAM despite often being the first responders to airway emergencies in ICU and on medical wards. We developed an AAM training program tailored for IM residents. Here, we present our experience from this curriculum.

Methods: IM residents received a didactic session introducing AAM and RSI with emphasis on peri-intubation patient care, followed by hands on training in simulation lab with bag mask ventilation, direct and video laryngoscopy, nasal/oral airways, and supraglottic airways. We surveyed the residents before and after the training.

Results: Out of approximately 60 residents who participated in the curriculum, 53 residents responded to the surveys. There was an overwhelmingly positive response at the end of each session. The mean reported comfort levels (scale: 1=very uncomfortable to 5=very comfortable) increased across all survey items: assessing indications for intubation (mean of 3.30 to 4.06), understanding a resident’s role in emergent airway management (2.53 to 3.96), evaluating for potentially difficult airways (2.13 to 3.91), preparing equipment for intubation (2.35 to 4.08), ability to bag mask ventilate (3.43 to 4.40), using nasal/oral airway devices (2.43 to 4.15), choosing sedation and paralytic medications (2.60 to 4.06), following difficult airway algorithm (1.88 to 3.91), and managing post-intubation complications (2.50 to 3.98).

Conclusions: IM residents, who are often first responders to in-hospital airway emergencies, should be comfortable managing advanced airways. Our Implementation of AAM and RSI curriculum resulted in increased comfort levels with management of emergent intubations. For these reasons, we believe that systematic AAM training should be part of the IM training curriculum.