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Anaesthesia. 2014 Jul;69(7):669-77. doi: 10.1111/anae.12601.

The effects of a displayed cognitive aid on non-technical skills in a simulated 'can't intubate, can't oxygenate' crisis.

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University of Queensland Cognitive Engineering Research Group, Brisbane, Queensland, Australia; Monash University Academic Board of Anaesthesia and Perioperative Medicine, Melbourne, Victoria, Australia; Monash Simulation, Monash Health, Melbourne, Victoria, Australia.


Guidelines outlining recommended actions are difficult to implement in the stressful, time-pressured situation of an airway emergency. Cognitive aids such as posters and algorithms improve performance during some anaesthetic emergencies; however, their effects on team behaviours have not been determined. In this study, 64 participants were randomly assigned into control (no cognitive aid) and intervention (cognitive aid provided) groups before a simulated 'can't intubate, can't oxygenate' scenario. Video analysis was undertaken of the non-technical skills and technical performance during the scenarios. All categories had higher Anaesthetists' Non-Technical Skills (ANTS) scores when a cognitive aid was supplied (mean (SD) total ANTS score 10.4 (3.1) vs. 13.2 (2.4), p < 0.001). The number of times the cognitive aid was used was associated with higher ANTS scores (ρ = 0.383, p = 0.002). A trend towards the establishment of an infraglottic airway within 3 min was also noted (control group 55.3% vs. intervention 76.9%, p = 0.076). Non-technical skills are improved when a cognitive aid is present during airway emergencies.

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