Residents lack knowledge and practical skills in handling the difficult airway

Background: Full-scale simulators have been developed in anaesthesia. We aimed at assessing Danish anaesthesia residents' knowledge and management of a standardized difficult airway situation in an advanced airway simulator. The reliability of the assessment was also determined. Methods: Thirty-six residents answered a questionnaire testing their knowledge on difficult airway management and practice patterns. Secondly, all residents attempted management of a standardized 'cannot ventilate, cannot intubate' airway scenario. Three observers independently assessed a video recording of the performance. Results: Only 17% of the residents passed the written test. Ninety-seven per cent stated that they had difficulties recalling the American Society of Anesthesiologists'(ASA) difficult airway algorithm and 53% did not know how to oxygenate through the cricothyroid membrane. Seventeen per cent had previously been involved in emergency situations with severe complications due to insufficient airway management. In the scenario 75% of the residents established ventilation using a laryngeal mask airway. After establishing ventilation, 26% would continue with surgery without a definitive airway, despite the risk of aspiration. Analysis of the interobserver agreement showed good (K = 0.63) to excellent (K = 0.78) consistency for objective parameters in the scoring scheme. Inter-observer reliability was satisfactory (R = 0.43) for trained Crisis Resource Management evaluators. Conclusions: Theoretical and practical education in difficult airway management needs to be improved among Danish anaesthesia residents. Simulator assessment should only be performed using well-defined objective parameters and trained assessors.