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Achieving proficiency in rigid bronchoscopy—a study in manikins

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Irish Journal of Medical Science (1971 -) Aims and scope Submit manuscript

Abstract

Background

Rigid bronchoscopy may be used to relieve acute airway obstruction following induction of anaesthesia and is a recommended option for management of the difficult airway. The ability of anaesthetists to perform rigid bronchoscopy has not been reported. We sought to explore the acquisition of procedural skill in rigid bronchoscopy by anaesthesiologists in a manikin.

Methods

In a prospective interventional study, participants were asked to perform 40 rigid bronchoscopies in a TruCorp AirSim Advance airway manikin, configured to a randomised sequence of easy or difficult laryngoscopic grades to which the participants were blinded. The primary outcome was stabilisation (the attempt after which no further reduction in procedural time occurred). Dental injury and oesophageal intubation were also recorded. Forty anaesthesiologists and 40 unskilled controls (without laryngoscopic skills) participated.

Results

In the easy model, stabilisation occurred at attempt 8 in the anaesthesiology group and 10 in the unskilled controls. In the difficult model, stabilisation occurred at attempt 10 in both groups. Dental injury was less common in the anaesthesiology group. The proportion of participants achieving procedural competency did not differ between groups in either the easy (35/40 vs. 30/40) or difficult model (32/40 vs. 25/40).

Conclusions

This study shows that the technical skill of rigid bronchoscopy can be acquired within 10 repetitions in a manikin model. As procedural competence and complication frequency vary with the laryngoscopic grade of the model, both easy and difficult configurations should be used for training. Advanced laryngoscopic skills are not required prior to training in this technique.

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Abbreviations

C&L:

Cormack and Lehane

CUSUM:

Cumulative sum method

SD:

Standard deviation

SEM:

Standard error of mean

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Funding

This study was funded by the College of Anaesthetists of Ireland.

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Authors and Affiliations

  1. Department of Anaesthesia, The Rotunda Hospital, Parnell Square, Dublin, Ireland

    Jonathan Royds, Muiris A Buckley, Mark D Campbell, Grace M. Donnelly, Roisin Ní Mhuircheartaigh & Conan L McCaul

  2. University of Cape Town, Cape Town, South Africa

    Michael F.M. James

  3. Mater Misericordiae University Hospital, Dublin, Ireland

    Roisin Ní Mhuircheartaigh & Conan L McCaul

  4. University College Dublin, Dublin, Ireland

    Conan L McCaul

Authors
  1. Jonathan Royds
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  2. Muiris A Buckley
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  3. Mark D Campbell
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  4. Grace M. Donnelly
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  5. Michael F.M. James
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  6. Roisin Ní Mhuircheartaigh
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  7. Conan L McCaul
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Corresponding author

Correspondence to Conan L McCaul.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Royds, J., Buckley, M.A., Campbell, M.D. et al. Achieving proficiency in rigid bronchoscopy—a study in manikins. Ir J Med Sci 188, 979–986 (2019). https://doi.org/10.1007/s11845-018-1944-5

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  • DOI: https://doi.org/10.1007/s11845-018-1944-5

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