DAS Project Grant

Royal Surrey County Hospital

Title
Comparison of sagittal versus transverse (G-CUT) ultrasound techniques in identifying the cricothyroid membrane

Amount
£909

Scientific Abstract
The cricothyroid membrane (CTM) is an alternative access to the airway to provide oxygenation. During a 'can't intubate, can't oxygenate' (CICO) situation, the front of neck airway access, also known as cricothyroidotomy is advocated. The landmark technique of identifying the CTM by digital palpation is fairly inaccurate (24-72%), even worse in obese subjects (0-46%). However, ultrasound has shown to increase the accuracy of identifying the CTM (62.5-100%) in limited studies. In identifying the CTM accurately with ultrasound, the complication rate of performing cricothyroidotomy could be decreased. We have recently developed the Guildford Cricothyroid membrane Ultrasound Technique (G-CUT), which is an ultrasound technique in identifying the CTM in the transverse plane. This new technique is accurate in identifying the CTM and also relatively easy and quick to perform. Hence, we propose conducting a prospective controlled observational study of comparing the accuracy and time taken to identify the CTM using the landmark technique and ultrasound techniques, both in sagittal and transverse planes in two subjects with different neck pathologies. Training will be provided to the anaesthetists involved in the study on both ultrasound techniques. Secondary outcomes include user confidence, learning and preference.

Aintree University Hospitals NHS Foundation Trust, Liverpool

Title
Evaluating anaesthetic trainee's ability and confidence to perform an emergency scalpel cricothyroidotomy after the implementation of a collaborative anaesthetic and surgical training programme

Amount
£4,920

Scientific Abstract
The Difficult Airway Society recommends that scalpel cricothyroidotomy be the preferred rescue technique in the event of the can't intubate, can't oxygenate (CICO) emergency. Promoting scalpel cricothyroidotomy's adoption poses a problem for trainers as anaesthetists have traditionally preferred needle cricothyroidotomy techniques and have previously been reluctant to perform scalpel cricothyroidotomy.

In our institution, all anaesthetic trainees assist at an elective surgical tracheotomy directly supervised by a consultant maxillo-facial surgeon. Although a different procedure to scalpel cricothyroidotomy, we believe it fosters valuable transferrable surgical skills and experience.
We wish to investigate whether surgical training alongside traditional manikin based CICO training increases both an anaesthetic trainee's confidence and technical ability to perform scalpel cricothyroidotomy. All anaesthetic trainees at Aintree Hospital receive this training.

We aim to recruit 10 NTN ST5+ anaesthetic trainees during their induction period into our hospital. During the study period those enrolled will undergo 3 identical high-fidelity simulations of a CICO scenario and 3 structured interviews to assess whether the training makes a difference to their confidence and technical abilities. These assessments will take place immediately before commencing the training program, on completing the program as well as unexpectedly 6 months later. We will also assess the package's feasibility.