30 September 2023: Clinical Research
The Impact of Implementing the Vortex Approach on Airway Management Performance in Stressed Medical Students: A Randomized Controlled Simulation Study
Michał Starosolski 1ABCDEFG* , Cezary Kapłan 2ABDEF , Alicja Kalemba 2ABCDEF , Karolina Majewska 2BCDEFDOI: 10.12659/MSM.940372
Med Sci Monit 2023; 29:e940372
Table 4 Comparison of the Vortex group and control group.
| Vortex group (n=48) | Control group (n=48) | Total (n=96) | p | |
|---|---|---|---|---|
| The Airway Management Outcome Score | ||||
| 0 | 6 (12.5%) | 20 (41.7%) | 26 (27.1%) | |
| 1 | 15 (31.3%) | 15 (31.3%) | 30 (31.2%) | |
| 2 | 27 (56.3%) | 13 (27.1%) | 40 (41.7%) | |
| Identical attempts | 11 (22.9%) | 18 (37.5%) | 29 (30.2%) | 0.1 |
| Use of any optimizations | 27 (56.3%) | 21 (43.8%) | 48 (50.0%) | 0.2 |
| Optimization applied in each subsequent attempt in the same lifeline | ||||
| Yes | 15 (31.3%) | 5 (10.4%) | 20 (20.8%) | |
| No | 11 (22.9%) | 18 (37.5%) | 29 (30.2%) | |
| N/A | 22 (45.8%) | 25 (52.1%) | 47 (49.0%) | |
| More than 3 attempts in one lifeline | 2 (4.2%) | 8 (16.7%) | 10 (10.4%) | |
| Face mask ventilation attempt: | 34 (70.8%) | 18 (37.5%) | 52 (54.2%) | |
| Successful | 28 (82.4%) | 10 (55.6%) | 38 (73.1%) | |
| Optimizations | 15 (44.1%) | 8 (44.4%) | 23 (44.2%) | 0.98 |
| LMA attempt: | 37 (77.1%) | 26 (54.2%) | 63 (65.6%) | |
| Successful | 24 (64.9%) | 18 (69.2%) | 42 (66.7%) | 0.7 |
| Optimizations | 10 (27%) | 6 (23.1%) | 16 (25.4%) | 0.7 |
| ETT attempt | 33 (68.8%) | 39 (81.3%) | 72 (75%) | 0.2 |
| Number of attempts: | 0.2 | |||
| →1–3 | 31 (93.9%) | 32 (82.1%) | 63 (87.5%) | |
| →4–7 | 2 (6.1%) | 7 (17.9%) | 9 (12.5%) | |
| Incorrect intubation: | 18 (54.5%) | 28 (71.8%) | 46 (58.3%) | 0.1 |
| →ETT in esophagus | 1 (3.0%) | 7 (17.9%) | 8 (11.1%) | |
| →ETT in bronchus | 4 (12.1%) | 7 (17.9%) | 11 (15.3%) | |
| →Traumatic | 9 (27.3%) | 16 (41.0%) | 25 (34.7%) | 0.5 |
| →Multiple same attempts | 11 (33.3%) | 17 (43.6%) | 28 (38.9%) | 0.5 |
| →Successful | 10 (30.3%) | 15 (38.5%) | 25 (34.7%) | |
| →Optimizations | 7 (21.2%) | 11 (28.2%) | 18 (25%) | |
| Cricothyrotomy: | 1.0 | |||
| Incorrect technique | 6 (12.5%) | 6 (12.5%) | 12 (12.5%) | |
| Ventilation: | ||||
| No | 0 | 6 (12.5%) | 6 (6.3%) | |
| Yes – appropriate | 12 (25.0%) | 4 (8.3%) | 16 (16.7%) | |
| Yes – not appropriate: | 36 (75.0%) | 38 (79.2%) | 74 (77.1%) | 0.08 |
| 1) Hyperventilation | 26 (54.2%) | 22 (45.8%) | 48 (50.0%) | |
| 2) Prolonged pauses | 3 (6.3%) | 5 (10.4%) | 8 (8.3%) | |
| 3)Poor mask seal | 7 (14.6%) | 9 (18.8%) | 16 (16.7%) | |
| 4) Too small volume | 21 (43.8%) | 28 (58.3%) | 49 (51.0%) | |
| 5) Too high volume | 0 | 1 (2.1%) | 1 (1.0%) | |
| Prolonged apnea (>1 min.) | 23 (47.9%) | 39 (81.3%) | 62 (64.6%) | |
| Overall favorable outcome – vortex approach applied + no prolonged apnea (>1 min.) | 20 (41.7%) | 5 (10.4%) | 25 (26.0%) | |