Feasibility of Endoscopic Exchange of i-gel® Supraglottic Airways Placed in the Field for Cardiac Arrest

Sean Trostel MD, Joseph Blackwell MD, Keegan Bradley MD, Stephen T. Constantine MD, Douglas Swanson MD, Michael A Gibbs MD

Objective: To describe the success and complication rates of a procedure utilizing a disposable endoscope to exchange an i-gel® supraglottic airway (SGA) for an endotracheal tube (ETT).

Methods: This was a single-arm, prospective, observational study conducted at Carolinas Medical Center. Patients >18 years of age who arrived at the emergency department with an i-gel® SGA in place were eligible for enrollment. In enrolled patients, a disposable endoscope was inserted into the SGA, navigated through the glottis and into the trachea, and cut with shears to produce an introducer over which a standard endotracheal tube could be placed within the trachea. Participating clinicians then recorded success or failure of the procedure, complications, and difficulties experienced during the procedure. The primary outcome was success rate of the exchange procedure, and secondary outcomes were rates of observed complications during the procedure.

Results: A total of 17 patients were enrolled, 76% of whom were male, with a median age of 60. The primary outcome of procedural success occurred in 65% of cases. Desaturation occurred in 12% of cases, and there were no recorded occurrences of esophageal intubation, aspiration, dysrhythmia, cardiac arrest, or airway injury. Procedural difficulties were common and included difficulty passing the ETT over the endoscope insertion tube and resistance with passing the insertion tube through the SGA.

Conclusion: Among a small cohort of adult patients arriving to an emergency department with an i-gel® supraglottic airway in place, this endoscopic exchange procedure showed a moderate success rate of 65%. Procedural difficulties were common, and desaturation occurred in 12% of cases. Further research is warranted to better understand factors that may contribute to procedural success.

Skin Color and Gender of High-Fidelity Simulation Manikins in Emergency Medicine Residency Training and their use in Cultural Humility Training

Marie Wofford, MD, MPH, Cortlyn Brown, MD, MPH, Bernard Walston, MD, Heidi Whiteside, MS, Joseph Rigdon, PhD, and Philip Turk, MS, PhD

Background: It is important for physicians to learn how to provide culturally sensitive care. One way to do this is by simulation. There are no peer-reviewed published studies that examine if the skin color or gender of the high-fidelity simulation manikins (HFSM) used by emergency medicine residency programs (EMRPs) reflect the US population nor if high-fidelity simulation (HFS) is used to teach cultural humility (CH). Cultural humility is defined as a lifelong process with a goal of fixing power imbalances and creating institutional accountability through learning about another’s culture as well as performing self-exploration about your own beliefs, identities, biases. We aimed to address that gap in the literature. Our primary objective was to evaluate what proportion of EMRPs use HFS to teach CH. Our secondary objective was to evaluate if the skin color and gender breakdown of the EMRP HFSM are representative of the US population.

Methods: We conducted a simple random sample of 80 EMRPs to characterize HFSM and CH training. Selected programs were emailed a questionnaire. Key outcomes included HFSM skin color and gender and if CH was taught via HFS. Point and interval estimates were calculated for the proportion of dark-, medium-, and light-colored manikins and the proportion of female and male manikins. Confidence intervals were employed to test the null hypothesis that dark/medium/light skin color was 20/20/60 and that female/male was 50/50. Both ratios were extrapolated from the US Census data.

Results: Our response rate was 74% (59/80). Fifty-five of 59 EMRPs that had manikins (0.93, 95% CI: 0.88, 0.99) reported data on a total of 348 manikins. Thirty-nine of the 55 EMRPs with manikins reported using HFS to teach CH (0.71, 95% CI: 0.60, 0.82).

Proportions of light-, medium-, and dark-colored manikins were 0.52 (95% CI: 0.43, 0.62), 0.38 (95% CI: 0.29, 0.47), and 0.10 (95% CI: 0.07, 0.14), respectively.

Proportions of male and female HFSM were 0.69 (95% CI: 0.64, 0.76) and 0.31 (95% CI: 0.24, 0.36), respectively. The null hypotheses that skin color follows a 60/20/20 split and gender follows a 50/50 split were rejected, as not all confidence intervals contained these hypothesized values.

Conclusions: While most EMRPs surveyed use HFS to teach CH, the manikins do not reflect the skin tone nor gender of the United States population.

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