Trigger Films & Cognitive Imprinting in Nurse Anesthesia Difficult Airway Education


Unanticipated difficult airway (DA) and “can’t intubate, can’t ventilate” (CICV) situations are rarely encountered in anesthesia practice, but present a high risk for adverse patient outcomes. Training student registered nurse anesthetists (SRNAs) to manage these low-incidence, high-mortality (LIHM) events presents a unique challenge as DA and CICV are not routinely encountered in clinical training but must be managed quickly and correctly to prevent patient harm.

Despite improvements in education, suchs as the use of High Fidelity Simulation (HFS), CICV events continue to contribute to death and cognitive deficiencies due to lack of oxygenation to the tissues and the brain, highlighting the need for improved teaching methods for all providers. This is especially important to the Department of Defense due to the level of deployments of military Certified Registered Nurse Anesthetists to austere environments with limited assistance and resources.


A Pre-Posttest design was used that assessed SRNAs’ performance after experiencing a “Can’t intubate, Can’t ventilate” scenario utilizing HFS. The SRNAs initial performance was evaluated to ascertain how long it would take them to call for help, time in placement of a supraglottic airway, and time to verbalize the need for a surgical airway. After the first encounter, the SRNAs watched a trigger film (TF) depicting an anesthesia provider who encountered a scenario that led to profound patient desaturation and how they managed the difficult airway scenario. The TF was followed by a facilitated group discussion that focused on difficult airway management. Following the discussion group, the SRNAs went through the scenario again and the same measures from the first scenario was reassessed.


Graduate School of Nursing


Graduate School of Nursing



Overall, the students consistently performed all critical steps in the difficult airway management faster after participation in the repeated high fidelity simulation scenario. There was a significant decrease in the time to call for help after watching the trigger film and performing in the second simulation encounter. The results of this project displays the importance of high fidelity simulation and how its use can improve essential skills in the field of anesthesia in a safe environment. Additionally, the use of trigger films can be a vital adjunct in the method that student nurse anesthetists are trained to ensure that military anesthesia providers can continue to practice independently and effectively in Military Treatment Facilities and the austere environment.