Abstract / Summary
Abstract Background. Emergency front-of-neck access (eFONA) by cricothyrotomy is the definitive rescue manoeuvre in a “cannot intubate, cannot oxygenate” (CICO) crisis, yet its extremely low incidence deprives anesthesiologists of real-world practice. We evaluated a structured one-day simulation-based cricothyrotomy curriculum. Methods. In this quasi-experimental pre–post study, 460 anesthesiologists from 31 provincial-level regions of China completed six annual sessions (2019–2026) of a standardized one-day program comprising a didactic lecture, ultrasound-guided cricothyroid membrane localization, expert demonstration, and small-group hands-on practice on a high-fidelity part-task trainer. Self-confidence in five procedural domains (5-point Likert) was measured at baseline (T0), after the didactic session (T1), and after hands-on practice (T2). Procedure time, a 33-item procedural checklist (score 0–66), and an 11-domain global rating scale (GRS, 11–77) were assessed at T1 and T2 by two trained, phase-blinded expert raters. Analyses included repeated-measures ANOVA and Friedman tests with Bonferroni-adjusted post-hoc comparisons, paired t-tests and Wilcoxon signed-rank tests with effect sizes, and linear mixed-effects models testing time × prior-experience interactions. Results. All 460 participants completed the program. Mean procedure time decreased from 113.2 ± 16.5 s to 78.7 ± 10.9 s (mean difference − 34.4 s, 95% CI − 35.0 to − 33.9; p < 0.001), checklist scores rose from 28.7 ± 4.8 to 52.7 ± 5.4 (Δ + 23.9, 95% CI 23.8 to 24.0; p < 0.001), and GRS scores rose from 32.6 ± 5.5 to 57.3 ± 5.7 (Δ + 24.7, 95% CI 24.6 to 24.9; p < 0.001). Total self-confidence increased from 13.7 ± 5.2 (T0) to 16.1 ± 4.7 (T1) and 20.2 ± 3.6 (T2) (Friedman p < 0.001; all Bonferroni-adjusted pairwise comparisons p < 0.001 except equipment-preparation confidence at T0 vs T1, which improved only after hands-on practice). Training gains were largest in participants with no prior cricothyrotomy experience (time × experience interaction, p < 0.001 for all outcomes). Confidence gains correlated with improvements in procedural speed but not with expert-rated quality. Post-training procedure times remained above the 40-s benchmark proposed for CICO rescue, indicating scope for mastery-oriented reinforcement. Conclusions. A structured one-day simulation curriculum substantially improved anesthesiologists’ cricothyrotomy performance and self-confidence, with the greatest absolute gains among inexperienced practitioners. Gains are best attributed to standardized goals, guided deliberate practice, and immediate feedback rather than simulator fidelity alone. Competency benchmarks and periodic refresher training should be incorporated to translate short-term gains into durable clinical readiness.