Multidisciplinary difficult airway simulation training: two year evaluation and validation of a novel training approach at a District General Hospital based in the UK.

Our objective was to devise and assess a multidisciplinary simulated course in training junior doctors for possible difficult airway scenarios. The authors have run a multi-disciplinary difficult airway simulation that was designed to simulate the stresses and complications of a live situation. The course comprised of six to eight difficult airway simulations (using a Laerdal SimMan2 mannequin remote controlled by a "driver") with two teams moving through the simulations over half a day. The simulation lasted 20 min and was followed by 40 min of in-depth structured facilitated debrief. The course was set in the anaesthetic room of a district general hospital theatre. Seventy-eight candidates (28 anaesthetic trainees, 18 ENT trainees, 19 theatre nurses and 13 operating theatre practitioners) attended this course over 6 training days set over 2 years. The main outcome measures of candidate feedback scored for eight questions on a 1-6 Likert scale. From the results, Audit of Trust inpatient airway fatalities revealed three deaths in 2 years leading up to the introduction of the simulation course. Re-audit of the subsequent 2 years, during which time the course was running, has shown no airway fatalities. A 100 % candidate feedback response rate was obtained. Delegates gave an average score of 4.8 to the simulator replicating the stress of 'live' situations; 5.5 to the simulator addressing training needs; 5.6 to the course improving clinical knowledge, teamwork, leadership and non-technical skills. In our conclusions, successful management of a difficult airway situation requires rapid evaluation, effective communication, strong leadership and teamwork, as well as knowledge of local environment and equipment. The results show that candidates felt an improvement in clinical knowledge, teamwork, leadership and non-technical skills, as well as the mutual understanding and respect between related medical and non-medical team members. In addition, audit of airway mortality showed a Trust-wide reduction in inpatient airway related mortality following the course. The results emphatically demonstrate the universal success of this multi-disciplinary training method for all team members, regardless of hierarchical position or background.

Evaluating Indices for Non-invasive Myocardial Recovery Assessment in LVAD-Supported Heart Failure Patients.

Accurate assessment of myocardial recovery (MR) under left ventricular assist device (LVAD) support is essential for clinicians to manage heart failure patients. However, current techniques for assessing MR are time-consuming, invasive, and infrequent. Measuring MR using indices derived from LVAD operating data instead provides a potential real-time alternative. Several of these indices for assessing the MR of LVAD-supported heart failure patients were collated from the literature and subject to a comprehensive comparative analysis. The objective of this analysis was to determine the most accurate index for assessing systolic cardiac function under LVAD-support, characterized by maximal end-systolic elastance (Emax), while remaining insensitive to preload & afterload. The indices were compared in computational simulation, utilizing an LVAD + cardiovascular system model to sweep through a large array of Emax and resistance conditions. Results demonstrated the index that correlated best with Emax, showing the highest accuracy, was the ratio between maximum flow acceleration and flow pulsatility (average R2 =0.9790). The same index also exhibited the lowest % variation (sensitivity) to preload & afterload (1.32% & 13.53% respectively). However, opportunities for improvement remain among current recovery assessment indices, with this study providing a baseline of performance for potential future indices to improve upon.Clinical relevance- This study presents a potential real-time measure of native cardiac function in LVAD-supported heart failure patients to support patient management and further recovery.