Sonographisch gestützte Identifikation des Ligamentum conicum in der Kopf-Hals-Ultraschalllehre

Zusammenfassung

Hintergrund Verlegungen der oberen Atemwege stellen akute Notfälle dar. Ultima Ratio zur Sicherung der Atemwege ist die Durchführung einer Koniotomie nach Identifizierung des Lig. conicum. Hier kann die Sonografie unterstützen. Ziel dieser Studie war die Etablierung eines Trainings zur Vermittlung dieser Kompetenzen.

Material Methoden Das Training bestand aus einer theoretischen Schulung mit anschließender Videopräsentation (je 10min) sowie einem praktischen Training (45min). Zur Messung der Vorerfahrungen, der Zufriedenheit mit dem Training sowie des subjektiven und objektiven Kompetenzlevels wurden vor (T1) und nach (T2) dem Training Evaluationen bearbeitet. Zu T2 wurde zudem eine praktische Prüfung von n=113 Teilnehmenden (TN) absolviert. Die Ergebnisse der praktischen Prüfung wurden durch einen standardisierten Bogen dokumentiert.

Ergebnisse Der größte Teil der TN hatte weder eine Koniotomie gesehen (64,6%) noch eigenständig durchgeführt (79,6%). In der subjektiven Kompetenzeinschätzung konnte eine signifikante Verbesserung (T1 zu T2) gemessen werden (p<0,001). Das Trainingsprogramm wurde in allen abgefragten Items positiv bewertet. In den praktischen Prüfungen erreichten die TN durchschnittlich 89,2% der möglichen Punkte und benötigten für die Identifizierung des Lig. conicum im Mittelwert 101±23 Sekunden.

Schlussfolgerung Strukturiertes Training zur sonografischen Identifizierung des Lig. conicum führt bereits in kurzer Zeit zu einer deutlichen Verbesserung der subjektiven Kompetenzen sowie zu einem hohen objektiven Kompetenzlevel. Zukünftig sollten solche Trainingsprogramme standardisiert in der Kopf-Hals-Ultraschallausbildung etabliert werden.

Abstract

Objective Upper airway obstructions are usually acute emergencies. Coniotomy is the last option to secure the airway and can be supported by sonography. The aim of this study was to establish a training program to teach these skills.

Material and methods The training consisted of theoretical training with an additional video presentation (10 minutes each) and practical training (45 minutes). Evaluations were completed before (T1) and after (T2) the training to measure prior experience and satisfaction with the training as well as subjective and objective competence levels. At T2, a practical test was also completed by n=113 participants. A standardized evaluation form was used to document the results of the practical test.

Results A large proportion of the participants had neither seen a coniotomy (64.6%) nor performed one independently (79.6%). Significant improvement (T1 to T2) was measured with regard to the subjective assessment of competence (p<0.001). The training received positive ratings for all items tested (scale ranges 1–2). During practical tests, the participants achieved an average of 89.2% of the possible points and needed a mean of 101 ±23 seconds to identify the conic ligament.

Conclusion Structured training for sonographic identification of the conic ligament leads to significant improvement in the subjective assessment of competence and a high objective competence level in a short period of time. This type of training should be standardized in head and neck ultrasound training in the future.

Schlüsselwörter

Kopf-Hals-Sonographie - Atemwegsmanagement - Ultraschallausbildung - Koniotomie - Ligamentum conicum - Ausbildung - ultraschallgestützte Interventionen - coniotomy

Keywords

Direct observation of procedural skills (DOPS) - Head and neck ultrasonography - airway management - ultrasound training - ultrasound-guided interventions - direct observation of procedural skills (DOPS)

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