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Clinical trial of Adult SCRAM™ Bag reports positive results image

The Adult SCRAM™ is an Emergency Airway Bag, providing a structured approach to airway management. It forms a system of advanced preparation and organisation of equipment and drugs; promoting the delivery of safe, timely, and well-governed emergency anaesthesia and tracheal intubation. It was conceived by Paul Swinton and Neil Sinclair, air ambulance paramedic with the Scottish Ambulance Service, and developed by Scottish Health Innovations Ltd (SHIL) and OpenHouse Products.

A clinical trial performed at The Royal London Hospital, has now shown use of SCRAM can “reduce delay to airway management, reduce cognitive load and provide an improved capability to manage anticipated and unanticipated airway events.”

Participant were recruited from the Anaesthesia Department at a busy major trauma centre. All participants had a minimum of 2 years’ experience in anaesthesia and emergency airway management and were familiar with the Difficult Airway Society guidelines for the management of an unexpected difficult airway.

A control group used a standard resuscitation trolley while the experimental group used the Adult SCRAM™ bag. Both groups were required to:

  • manage a simulated difficult airway scenario outwith the operating theatre, using an airway training mannequin
  • prepare the equipment required (kit dump) in keeping with the Difficult Airway Society guidelines (Frerk et al., 2015) including equipment for front of neck access
  • declare when they had all required equipment ready before they could proceed to managing the airway

The scenario was stopped on completion of the kit dump. When compared to the control group, the trial found that use of the SCRAM™ Bag compared to the resuscitation trolley produced:

  • a 29% reduction in time taken to prepare the equipment (kit dump) necessary for the procedure (112 ± 30 vs 157 ± 45, p = 0.0001)
  • a less challenging system to use, as reported by participants (18.36 ± 16.4 mm vs 50.64 ± 22.9 mm, p < 0.001)
  • an 87.5% reduction in the total number of errors (1 (IQR 1–3) vs 8 (IQR 5–9), p = 0.03)

Commenting on the outcomes of the trial, Paul Swinton, co-inventor of the Adult SCRAM™ Bag, said: “Remote site emergency airway management is challenging. Poor planning and interrupted workflow at kit dump stage are significant contributors to morbidity and mortality. SCRAM™ facilitates a quicker, less challenging kit dump with, perhaps more importantly, significantly fewer errors.”

Gillian Henderson, Head of Project Management at SHIL, said: “SCRAM™ has been developed with the medical knowledge of front line health professionals and it is valuable to have the intended outcomes validated through this research. It supports the overall purpose of SHIL which is to work with health professionals to develop products and services that make a positive difference to patient care.”

SHIL work in partnership with NHS Scotland to identify, protect, develop and commercialise healthcare innovations to improve patient care. Following the success of the Adult SCRAM™ Bag, the SCRAM portfolio has now diversified to include Paediatric SCRAM™ Bag and the Paediatric EMS SCRAM™, with additional variations in development.

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