8/13/2019 Michaela Kolbe Et Al.

1/13

Training technical and non-technical skills for managing

unexpected difficult airways

in anesthesiaMichaela Kolbe, Mona Weiss, Gudela Grote (ETH Zurich)

Bastian Grande, Axel Knauth, Micha Dambach, Adrian

Marty, Donat R. Spahn (University Hospital Zurich)

8/13/2019 Michaela Kolbe Et Al.

2/13

ComTrainCombined training of technical

and non-technical skills

For managing unexpecteddifficult airway situations

For doctors and nurses

Simulation-basedOngoing project

8/13/2019 Michaela Kolbe Et Al.

3/13

Why focusing on unexpected

difficult airway situations?Most common cause of anesthetic death or brain

damage; associated with severe morbidity and

mortality (Abernathy et al., 2010)So far considered only from perspective of single

anesthesia care provider - the fact that it involves

more than just one single anesthesiologist (=

Team) not yet acknowledgedTeamwork likely to break down during stress

(Driskell et al., 1999)

8/13/2019 Michaela Kolbe Et Al.

4/13

ComTrain

! Training teamsas they occur in dailyanesthesia life (i.e., residents, nurses,

attendings if possible)! Training technical & non-technical

skills! Training via simulation (e.g., unexpected

difficult intubation; CVCI; using SimMan(Laerdal)) and structured debriefing

8/13/2019 Michaela Kolbe Et Al.

5/13

Non-technical skillsCRM-principles (Rall &

Gaba, 2005)Anaesthetists Non-

Technical Skills (ANTS)(Fletcher et al., 2003)Previous research of the

effectivity of anesthesia

teams (e.g.., Knzle etal., 2010a,b; Kolbe et al.,

2011; Manser et al.,

2009)

8/13/2019 Michaela Kolbe Et Al.

6/13

Technical skills

8/13/2019 Michaela Kolbe Et Al.

7/13

8/13/2019 Michaela Kolbe Et Al.

8/13

Structured Debriefing

8/13/2019 Michaela Kolbe Et Al.

9/13

Structured Debriefing

8/13/2019 Michaela Kolbe Et Al.

10/13

Structured Debriefing

8/13/2019 Michaela Kolbe Et Al.

11/13

8/13/2019 Michaela Kolbe Et Al.

12/13

First Conclusions! Self-efficacy significantly increases after training - this suggests a

positive effect of the combined debriefing methods that engage aproactive and engaging learning environment

! The structured debriefing is perceivd as encouraging and stimulating -pointing to a fruitful integration of different debriefing techniques

! The combined technical and non-technical training is evaluated ashighly relevant and applicable to the work context

! While the training has only moderate or no effects on most safetyattitudes, perceptions of teamwork climate decrease after training -

might be due to a more critical judgement of teamwork; safetyattitudes no good criterion for assessing training impact (Cooper et al.,

2008)! Both residents and nurses benefit from a combined technical and non-

technical skills training

8/13/2019 Michaela Kolbe Et Al.

13/13

Thank you