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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. 1Intensive Care Medicine, University Hospital South Manchester NHS Foundation Trust, Manchester, UK
  2. 2University of Manchester, Manchester, UK
  3. 3Manchester Academic Health Sciences Centre, Manchester, UK
  4. 4Intensive Care Medicine, Central Manchester NHS Foundation Trust, Manchester, UK
  5. 5Intensive Care Medicine, Royal Bolton Hospital, Farnworth, UK
  6. 6Intensive 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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