Evaluating Perceived Barriers to Cognitive Aid Use Among Anesthesia Providers During Malignant Hyperthermia, Myocardial Ischemia, and Unanticipated Difficult Airway

Background: A cognitive aid is defined by the Stanford Anesthesia Cognitive Aid Group as a visual in any form intended to enhance cognition and improve adherence to medical best practices. While the efficacy of cognitive aid use during simulated, intraoperative emergencies is well supported in the current literature, their use in anesthesia practice remains limited. Aim: The aim of this doctoral capstone paper is to investigate perceived barriers to cognitive aid use in the operating room among anesthesia providers during various emergency situations. Methodology: An anonymous survey was disseminated to 149 certified registered nurse anesthetists and anesthesiologists at two large academic institutions to explore actual and potential barriers that preclude cognitive aid use during three specific intraoperative emergencies: malignant hyperthermia, myocardial ischemia, and unanticipated difficult airway. Results: The survey was completed by 35 anesthesia providers. The three most frequently reported perceived barriers to cognitive aid use for all three emergency scenarios were: (a) would have distracted/delayed patient care, (b) did not know a cognitive aid was available, and (c) not enough help in the room (nobody available as the reader). Conclusion: While the current literature vastly supports the use of cognitive aids during simulated, intraoperative emergency scenarios, studies investigating their use in practice is limited. Our survey identified barriers to cognitive aid use in three specific emergency situations. Future research should focus on interdisciplinary cognitive aid training, access to cognitive aids, and use of a reader