[Transfer of a cockpit strategy to anesthesiology : Clinical example: introduction of canned decisions to solve cannot intubate cannot oxygenate situations].

backgroundSafety strategies in civil aviation are well-established. The authors present a possible structure for induction of anesthesia, which includes elements of the so-called cockpit strategy. The objective is to reduce anesthesia-related mortality caused by the unexpected difficult airway through early detection and solution of cannot intubate cannot oxygenate (CICO) situations.

methodsAfter approval by the responsible ethics committee, a prospective pilot study was conducted to analyze the process quality of uncomplicated induction of anesthesia on a simulator using audiovisual recording. An evaluation list with 44 items was created, which met the following requirements: items were dichotomous, accessible to an audiovisual evaluation and according to current scientific consensus should be considered during induction of anesthesia. Standard induction of anesthesia was supplemented by several crew resource management elements (cockpit strategy). Two canned decisions (CD, CD 1: end tidal CO

resultsThe cockpit strategy significantly improved the process quality during the simulated induction of anesthesia (78% vs. 36% items fulfilled), while the duration of induction was reduced by 36%. In the subsequent 6‑year study period, 7 CICO situations with emergency coniotomy occurred. All teams performed in accordance with the algorithm and with respect to the CDs. No patient suffered from hypoxia or any other damage.

conclusionThe transfer and implementation of a cockpit strategy in anesthesiology for improvement of patient safety is possible. The acceptance of the aviation safety strategy in medicine is a necessary prerequisite. A profound training in technical and non-technical skills and regular team training to solve CICO situations must be an integral part of advanced training in anesthesiology.