Tracheal intubation is the gold standard in emergency airway management. One way of measuring intubation quality is first pass success rate (FPSR). Mastery of tracheal intubation and maintenance of the skill is challenging for non-anesthesiologists. A combination of individual measures can increase FPSR. Videolaryngoscopy is an important tool augmenting laryngeal visualization. Bougie-first strategy can further improve FPSR in difficult airways. Standardized positioning maneuvers and manipulation of the soft tissues can enhance laryngeal visualization. Fresh frozen cadavers (FFC) are superior models compared to commercially manufactured manikins. By purposefully manipulating FFCs, it is possible to mimic the pre-hospital intubation conditions of helicopter emergency medical service (HEMS). Twenty-four trauma surgeons (12 per Group, NOVICES: no pre-hospital experience, HEMS: HEMS physicians) completed an airway training course using FFCs. The FFCs were modified to match airway characteristics of 60 prospectively documented intubations by HEMS physicians prior to the study (BASELINE). In four scenarios the local HEMS airway standard (1: unaided direct laryngoscopy (DL), OLD) was compared to two scenarios with modifications of the intubation technique (2: augmented DL (bougie and patient positioning), 3: augmented videolaryngoscopy (aVL)) and a control scenario (4: VL and bougie, positioning by participant, CONTROL). FPSR, POGO score, Cormack and Lehane grade and duration of intubation were recorded. No participant had anesthesiological qualifications or experience in VL. The comparison between CONTROL and BASELINE revealed a significant increase of FPSR and achieved C&L grade for HEMS group (FPSR 100%, absolute difference 23%, p ≤ .001). The use of videolaryngoscopy, bougie, and the application of positioning techniques required significantly more time in the CONTROL scenario (HEMS group: mean 34.0 s (IQR 28.3–47.5), absolute difference to BASELINE: 13.0 s, p = .045). The groups differed significantly in the median number of real-life intubations performed in any setting (NOVICES n = 5 (IQR 0–18.75), HEMS n = 68 (IQR 37.25–99.75)). In the control scenario no significant differences were found between both groups. The airway characteristics of the FFC showed no significant differences compared to BASELINE. Airway characteristics of a pre-hospital patient reference group cared for by HEMS were successfully reproduced in a fresh frozen cadaver model. In this setting, a combination of evidence based airway management techniques results in high FPSR and POGO rates of non-anesthesiological trained users. Comparable results (FPSR, POGO, duration of intubation) were achieved regardless of previous provider experience. The BOAH concept can therefore be used in the early stages of airway training and for skill maintenance.

中文翻译：

---

重建现实：使用视频喉镜和探条 FIRST 策略验证新鲜冷冻全尸体气道训练

气管插管是紧急气道管理的金标准。测量插管质量的一种方法是首次通过成功率 (FPSR)。对于非麻醉医师来说，掌握气管插管和维持技能是一项挑战。单个措施的组合可以提高 FPSR。视频喉镜检查是增强喉部可视化的重要工具。布吉优先策略可以进一步提高困难气道的 FPSR。标准化的定位操作和软组织的操作可以增强喉部的可视化。与商业制造的人体模型相比，新鲜冷冻尸体 (FFC) 是更好的模型。通过有目的地操纵 FFC，可以模拟直升机紧急医疗服务 (HEMS) 的院前插管条件。24 名创伤外科医生（每组 12 名，新手：没有入院前经验，HEMS：HEMS 医师）使用 FFC 完成了气道培训课程。对 FFC 进行了修改，以匹配研究前 HEMS 医生前瞻性记录的 60 例插管的气道特征（基线）。在四种情况下，将当地 HEMS 气道标准（1：独立直接喉镜检查 (DL)，OLD）与插管技术修改的两种情况进行比较（2：增强 DL（探条和患者定位），3：增强视频喉镜检查 (aVL) ) 和控制场景（4：VL 和探条，参与者定位，控制）。记录 FPSR、POGO 评分、Cormack 和 Lehane 等级以及插管时间。没有参与者具有 VL 的麻醉学资格或经验。CONTROL 和 BASELINE 之间的比较显示 FPSR 显着增加并实现了 C& HEMS 组的 L 级（FPSR 100%，绝对差 23%，p ≤ .001）。在 CONTROL 方案中，使用视频喉镜、探条和定位技术需要更多的时间（HEMS 组：平均 34.0 s (IQR 28.3–47.5)，与基线的绝对差异：13.0 s，p = .045）。各组在任何环境中进行的实际插管次数中位数存在显着差异（新手 n = 5 (IQR 0-18.75)，HEMS n = 68 (IQR 37.25-99.75)）。在控制方案中，两组之间没有发现显着差异。FFC 的气道特征与 BASELINE 相比没有显着差异。由 HEMS 照顾的院前患者参考组的气道特征在新鲜冷冻尸体模型中成功再现。在这种设定下，基于证据的气道管理技术的组合导致非麻醉训练用户的高 FPSR 和 POGO 率。无论以前的提供者经验如何，都获得了可比较的结果（FPSR、POGO、插管时间）。因此，BOAH 概念可用于气道训练的早期阶段和技能维护。