• Aditee P Ambardekar, Eric B Rosero, Ravi Bhoja, Jerry Green, Brett A Rebal, Abu T Minhajuddin, Matthew S Kosemund, Oren T Guttman, and David W Mercier.
• From the Department of Anesthesiology and Pain Management (A.P.A., E.B.R., R.B., J.G., D.W.M.), University of Texas Southwestern Medical Center, Dallas; US Anesthesia Partners-Texas Central (B.A.R.), Austin; Department of Clinical Sciences (A.T.M.), University of Texas Southwestern Medical Center; Department of Surgery Center for Minimally Invasive Surgery (M.S.K.), University of Texas Southwestern Medical Center, Dallas, TX; and Department of Anesthesiology (O.T.G.), Thomas Jefferson University Medical Center, Philadelphia, PA.
• Simul Healthc. 2019 Apr 1; 14 (2): 96-103.

IntroductionThe American Society of Anesthesiologists (ASA) difficult airway algorithm and the Vortex approach are difficult airway aids. Our objective was to demonstrate that a simpler cognitive model would facilitate improved decision-making during a process such as difficult airway management. We hypothesized the simpler Vortex approach would be associated with less anxiety and task load.MethodsMedical students were randomized to the ASA algorithm (n = 33) or Vortex approach (n = 34). All learned basic airway techniques on day 1 of their rotation. Next, they watched a video of their respective aid then managed a simulated airway crisis. We assessed decision-making using a seven-point airway management score and a completeness score. Completeness was at least one attempt at each of four techniques (mask ventilation, supraglottic airway, intubation, and cricothyrotomy). Two validated tools, the State-Trait Anxiety Inventory Form Y and the National Aeronautics and Space Administration Task Load Index, were used to assess anxiety and task load.ResultsStudents in the Vortex group had higher airway management scores [4.0 (interquartile range = 4.0 to 5.0) vs. 4.0 (3.0 to 4.0), P = 0.0003] and completeness (94.1% vs. 63.6%, P = 0.003). In the ASA group, the means (SD) of National Aeronautics and Space Administration Task Load Index scores of 55 or higher were observed in mental [61.4 (14.4)], temporal [62.3 (22.9)], and effort [57.1 (15.6)] domains. In the Vortex group, only the temporal load domain was 55 or higher [mean (SD) = 57.8 (25.4)]. There was no difference in anxiety.ConclusionsMedical students perform better in a simulated airway crisis after training in the simpler Vortex approach to guide decision-making. Students in the ASA group had task load scores indicative of high cognitive load.

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