Background: Front-of-neck airway rescue in a cannot intubate, cannot oxygenate (CICO) scenario with impalpable anatomy is particularly challenging. Several techniques have been described based on a midline vertical neck incision with subsequent finger dissection, followed by either a cannula or scalpel puncture of the now palpated airway. We explored whether the speed of rescue oxygenation differs between these techniques. Methods: In a high-fidelity simulation of a CICO scenario in anaesthetised Merino sheep with impalpable front-of-neck anatomy, 35 consecutive eligible participants undergoing airway training performed scalpelefingerecannula and scalpelefingerebougie in a random order. The primary outcome was time from airway palpation to first oxygen delivery. Data, were analysed with Cox proportional hazards. Results: Scalpelefingerecannula was associated with shorter time to first oxygen delivery on univariate (hazard ratio [HR]¼ 11.37; 95% confidence interval [CI], 5.14e25.13; P<0.001) and multivariate (HR¼8.87; 95% CI, 4.31e18.18; P<0.001) analyses. In the multivariable model, consultant grade was also associated with quicker first oxygen delivery compared with registrar grade (HR¼3.28; 95% CI, 1.36e7.95; P¼0.008). With scalpelefingerecannula, successful oxygen delivery within 3 min of CICO declaration and 2 attempts was more frequent; 97% vs 63%, P<0.001. In analyses of successful cases only, scalpelefingerecannula resulted in earlier improvement in arterial oxygen saturations (e25 s; 95% CI, e35 to e15; P<0.001), but a longer time to first capnography reading (þ89 s; 95% CI, 69 to 110; P<0.001). No major complications occurred in either arm. Conclusions: The scalpelefingerecannula technique was associated with superior oxygen delivery performance during a simulated CICO scenario in sheep with impalpable front-of-neck anatomy.

Porcine stifles are cost effective, accessible, allow for meniscal repair and are suitable for arthroscopic access and view. Our view is that they are an ideal training model for arthroscopic meniscal repair, small joint arthroscopy and anterior cruciate ligament reconstruction.

The use of bovine carpal joints is a cost-effective, safe and easily reproducible model for education on basic anterior cruciate ligament repair skills and technique prior to patient contact.

Background: Anterior cruciate ligament (ACL) reconstruction and meniscal repair are two commonly performed arthroscopic soft tissue surgeries. It can be challenging for training surgeons to become proficient in these techniques. The aim of our study is to investigate the viability of porcine stifles as training models for ACL reconstruction and meniscal repair. Method: A training session was held with various participants comparing the use of porcine stifles vs. sawbone replicas. Tendon harvesting, joint arthroscopy, meniscal repair and ACL reconstruction were performed on both groups of joints. The two training methods were compared by the completion of a questionnaire by four participants. Results: Porcine stifles were found to be a suitable alternative to human knee joints. Tactile sensation of performing these procedures with porcine stifles more closely resembled that of a human knee. Visualisation of the joint and its structures was considerably easier in the saw bone model, but the porcine stifle better resembled real life scenarios. The medial joint compartment was notably more difficult to visualise and access relative to the lateral compartment, increasing procedure time when repairing the medial meniscus. Conclusion:Porcine stifles provide a suitable model for education and surgical training for ACL reconstruction and meniscal repair for trainee surgeons. They are easy to procure, cost-effective, and better replicate the complexities of these procedures in human knees compared to sawbones. We believe that practically this provides an ideal platform for simulation scenarios which are similar to humans and fulfils the ethical mandates of beneficence and non-maleficence.