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The role of high-fidelity simulation in designing emergency airway management algorithms: the experience of the UK National Tracheostomy safety project
  1. Brendan A McGrath1,2,3,
  2. Catherine Doherty4,
  3. John A Moore4,
  4. Lucy Bates5,
  5. Gareth Hughes2,3,6,
  6. Dougal Atkinson4,
  7. Hannah E Donaldson1
  1. 1 Intensive Care Medicine, University Hospital South Manchester NHS Foundation Trust, Manchester, UK
  2. 2 University of Manchester, Manchester, UK
  3. 3 Manchester Academic Health Sciences Centre, Manchester, UK
  4. 4 Intensive Care Medicine, Central Manchester NHS Foundation Trust, Manchester, UK
  5. 5 Intensive Care Medicine, Royal Bolton Hospital, Farnworth, UK
  6. 6 Intensive Care and Respiratory Medicine, University Hospital South Manchester NHS Foundation Trust, Manchester, UK

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A variety of simulation-based strategies have been developed to facilitate technical and non-technical learning in simulated airway scenarios, some of which follow predetermined algorithms to guide the responders.1 2 However, simulation can also be used to devise the responses to emergency scenarios, particularly useful for relatively rare events. We describe this novel use of in-situ simulation to iteratively test and refine practice guidelines during simulated tracheostomy emergencies. These methods can challenge established expert peer review processes for developing airway algorithms.


The UK National Tracheostomy Safety Project (NTSP) was tasked with improving emergency tracheostomy management. We recognised that feedback from simulated scenarios could be used in the development of emergency algorithms (figure 1). A Working Party was established comprising medical, nursing and allied health professionals with experience of simulation training and tracheostomy care, supported by representatives of key organisations with a stated interest in airway management.2

Figure 1

Timeline detailing the key steps in developing the emergency algorithms.

Four distinct simulated scenarios were developed from clinical reports.3 Manikins deteriorated physiologically (eg, progressive hypoxia), intended to prompt specific actions from participants. Scenarios were tested for validity by four members of the Working Party (BAM, DA, LB and JAM) prior to consenting multidisciplinary participants attempting them. Formal ethical approval was not required but local research governance procedures were followed. Simulators used were SimMan Essential (Laerdal, Stavanger, Norway) and MetiMan …

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  • Contributors The concept of the study was designed by BAM, DA, JAM and LB. Data collection was also performed by BAM, DA, JAM and LB. Literature review and data analysis were led by BAM, updated by HED and GH. Manuscript writing had contributions from all, led by BAM, HED and GH.

  • Funding BMG, LB and DA have received sponsorship from CAE Healthcare to attend HPSN Europe and World events in 2012 and 2013. Sponsorship covered travel and subsistence only.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data sharing statement Data were used to inform other publications notably the 2012 guidelines. Unpublished data are not controlled and not considered scientifically sound enough for publication. Further information can be obtained from the corresponding author.

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