Over the past 50 years, anesthesia has seen remarkable progress in terms of quality and patient safety. A SFAR-Inserm survey showed a tenfold decrease in mortality during anesthesia between 1980 and 2000.

Critical situations in anesthesia are rare, but when they occur, it is essential to detect and manage them quickly. This detection requires situational awareness, and recovery maneuvers rely on various non-technical skills such as leadership, teamwork, effective communication, and effective workload management.

Crisis Management and Cognitive Aids in Anesthesia

In anesthesia/intensive care, critical situations can be diverse: intraoperative hypotension, intraoperative hypoxemia, non-intubable and non-oxygenable patients, cardiac arrest during anesthetic induction, etc.

Although some of these situations may be frequent, they can generate significant stress and sometimes compromise the patient's functional or vital prognosis.

Due to their unusual nature, critical situations in the operating room or intensive care unit require mastery of crisis resource management skills: the ability to analyze the situation, mobilization Knowledge and resources, individual technical skills that can be confronted with stress, human cognitive functioning, and the challenges of teamwork. However, in emergency situations, time and cognitive abilities are often limited by stress, a very high mental workload, and potentially increased operational complexity. Mentally recalling the list of actions to take can be difficult and inefficient; certain cognitive biases, such as tunnel vision (fixation error) or confirmation bias, can distort our awareness of the situation. Effective crisis management relies on several principles that can already be implemented and mastered in routine situations. These principles are those of CRM, or Crew Resource Management, developed by NASA, among others. CRM has been adapted to medicine, notably by the anesthesiologist David Gaba, and translated as Crisis Resource Management. CRM is based on several principles. The implementation of cognitive aids and early intervention are examples.

A fundamental element of Crew Resource Management, the use of cognitive aids must become second nature for healthcare professionals in the modern medicine of tomorrow. Whether dealing with risks in aviation, fire, or military operations, cognitive aids, also known as "reminders," "memory aids," or "emergency procedures," are essential.

Cognitive aids consist of structured, step-by-step information, as close as possible to the event, designed to improve the performance of the medical and paramedical team by guiding reasoning, listing the sequence of actions, and preventing steps from being overlooked. They can be written for routine or crisis situations in several forms (cognitive aids, emergency sheets, checklists) and on various media (paper or digital).* In concrete terms, cognitive aids are tools created to guide users in carrying out one or more tasks. Their main objectives are to reduce the risk of errors and increase the speed of task execution. Cognitive aids allow for the standardization of processes to avoid oversights and ensure that no step is omitted. To this end, they are designed to be used during the performance of these tasks.

Most often, they correspond to a list of specific tasks allowing healthcare professionals to recall the different stages of complex care but also to apply their knowledge appropriately to an emergency situation.

To maximize their effectiveness, cognitive aids are intended to be a team tool that requires sound knowledge and appropriation, particularly through the use of cognitive aids during team crisis simulation exercises.*

With the main objective of reducing the risk of error, the SFAR actively participates in this development, with fact sheets available on its site concerning the management of critical situations in anesthesia and intensive care.

Stanford University and Harvard University were pioneers in the design of cognitive aids in anesthesia. Here are some visuals and links for inspiration.

Australian anesthesiologist David BORSHOFF, whom we had the honor of featuring in Patient Safety Report No. 12, was also the originator of the ACM - Anesthesia Crisis Manual - which the European Society of Anesthesiology and Intensive Care makes available on its website

Anesthesiologist Jean Christophe CEJKA was also one of the first to digitize and make cognitive aids dynamic with the MAX tool by MEDAE.

Finally, let's note The recent efforts of the French Society of Anesthesia and Intensive Care in this area, with the provision of fact sheets on its website concerning the management of critical situations in anesthesia and intensive care, and the association with Human Factors in Healthcare for the creation of professional practice recommendations dedicated to human factors in crisis situations.

SafeTeam Academy and Crisis Management in Anesthesia

SafeTeam Academy has developed a new e-learning course for anesthesiologists and nurse anesthetists, "Managing Critical Situations in the Operating Room," which allows for Continuing Professional Development (CPD) validation.

Through immersive video cases, the course addresses very concrete anesthesia situations, allowing learners to challenge crisis management:

• Intraoperative arterial hypotension under anesthesia general
• Intraoperative hypoxemia under general anesthesia
• Patient cannot be intubated or oxygenated
• Cardiocirculatory arrest during anesthetic induction.

CRM in general, and the use of cognitive aids in particular, are integral to our approach and are included in most of our training courses, especially the one on crisis management for which you can be accredited.

Log in to your mondpc.fr account and search for the organization 9827 ASN ANESTHESIA SAFETY NETWORK to discover our CPD (Continuing Professional Development) activity on managing critical situations in the operating room.

This new training program offers learners the opportunity to develop their soft skills, understand Crisis Resource Management, and improve their leadership.

If you too would like to participate in For improved patient care reliability, SafeTeam Academy training courses are for you! To learn more about our Continuing Professional Development (CPD) activities, please write to the following address: contact@safeteam.academy. *Anesthesia & Resuscitation, Volume 6, French Society of Anesthesia and Resuscitation *https://sfar.org/espace-professionel-anesthesiste-reanimateur/outils-professionnels/boite-a-outils/aides-cognitives-en-anesthesie-reanimation/