A Novel Expeditionary Perfused Cadaver Model for Trauma Training in the Out-of-Hospital Setting

Redman, Theodore T.; Ross, Elliot

doi:10.1016/j.jemermed.2018.05.032

Cited by 10 publications

(6 citation statements)

References 16 publications

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“…The important advantages of this circulation model include pulsatility, realism of vessel dissection, tactile feedback, and simulated bleeding from the injured site at vessel and organ—all of which facilitate the practice of decision-making when surgically treating an unstable patient [ 10 , 11 ]. The perfused cadaver model continues to evolve, and it has now been developed for out-of-hospital battlefield medical training [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…The perfused cadaveric model simulation method, which was introduced to improve the level realism in anatomical approach and professional skills training, has been implemented in various fields of care, including advanced surgical skills, endovascular procedures, and complex and critical scenarios [4,5,7,8,[10][11][12][13][14][15][16][17][18][19][20][21]. The achievement of hemostasis in military tourniquet training obtained using the perfused cadaveric model was superior to that obtained from other tourniquet training techniques [22].…”

Section: Discussionmentioning

confidence: 99%

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Efficacy of a perfused cadaver model for simulated trauma resuscitation in advanced surgical skills training

et al. 2022

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Background To develop a perfused cadaveric model for trauma surgery simulation, and to evaluate its efficacy in trauma resuscitation advanced surgical skills training. Methods Fourteen fourth-year general surgery residents attended this workshop at Siriraj Hospital (Bangkok, Thailand). Inflow and outflow cannulae and a cardiopulmonary bypass pump were used to create the perfusion circuit. Inflow was achieved by cannulating the right common carotid artery, and outflow by cannulation of both the right common femoral artery and the internal jugular vein. Arterial line monitoring was used to monitor resuscitation response and to control perfusion pressure. The perfusion solution comprised saline solution mixed 1:1 with glycerol (50%) and water with red food dye added. Advanced surgical skills during life-threatening injuries and damage control resuscitation operations were practiced starting from the airway to the neck, chest, peripheral vessels, abdomen, and pelvis. Resuscitative endovascular balloon occlusion of the aorta (REBOA) was also practiced. Post-workshop survey questions were grouped into three categories, including comparison with previous training methods; the realism of anatomical correlation and procedures; and, satisfaction, safety, and confidence. All questions and tasks were discussed among all members of the development team, and were agreed upon by at least 90% of experts from each participating medical specialty/subspecialty. Results The results of the three main groups of post-workshop survey questions are, as follows: (1) How the training compared with previous surgical training methods—mean score: 4.26/5.00, high score: 4.73/5.00; (2) Realism of anatomical correlation and procedures—mean score: 4.03/5.00, high score: 4.60/5.00; and, (3) Satisfaction, safety, and confidence—mean score: 4.24/5.00, high score: 4.47/5.00. Conclusion The developed perfused cadaveric model demonstrated potential advantages over previously employed conventional surgical training techniques for teaching vascular surgery at our center as evidenced by the improvement in the satisfaction scores from students attending perfused cadaveric training compared to the scores reported by students who attended earlier training sessions that employed other training techniques. Areas of improvement included ‘a more realistic training experience’ and ‘improved facilitation of decision-making and damage control practice during trauma surgery’.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Efficacy of a perfused cadaver model for simulated trauma resuscitation in advanced surgical skills training

et al. 2022

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“…Thus, the surgeon might push his dissection further, as the CMOR is easier to identify as its caliber increases with the quantity of liquid perfused. In their model, Redman and Ross used a saline solution with continuous infusion and con rmed that a perfused cadaver that bleeds provides more training value and allows for more procedures to be accurately simulated and performed [34]. The successful establishment of a venous perfused pulsatile cadaveric circulation was rst described by Garrett et al in 2001 [35].…”

Section: Discussionmentioning

confidence: 99%

Morphologic Study of the Corona Mortis Using the Simlife ® Technology

BEYA

Danion

Vendeuvre

et al. 2022

Preprint

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Purpose Open book pelvic ring fractures are potentially life-threatening, due to their instability and major haemorrhage risk. If a pelvic belt could initially control the bleeding, the definitive management involves an open reduction and internal fixation. However, the pelvic approach remains a technical challenge, as the surgeon wants to prevent any iatrogenic damage of the vascular loop located in the retropubic area called corona mortis (CMOR). Recently, the cadaver perfused SIMLife® technology has been developed to improve the surgeon training, out of the operating room. This study aimed to compare two models of cadaveric dissection, to assess the interest of the perfused SIMLife® in the identification of the CMOR and its topography. Methods Twelve human cadaveric pelvises have been dissected, following two protocols. Twelve hemipelvises of the dissections were performed without perfusion (Model A), whereas the 12 other hemipelvises have been prepared with the SIMLife® pulsatile perfusion (Model B). The prevalence, length, and diameter of the CMOR have been reported, along with the distance between the CMOR and the pubic symphysis. Results The CMOR has been found in 66,67% of the cases. The length, the diameter and the distance between the CMOR and the pubic symphysis were significantly higher in model B (respectively p = 0.029, p = 0.01, and p = 0.022). Conclusion These results suggest that the CMOR is easier to identify and to dissect with the SIMLife® perfusion. As part of the surgical training of any trauma surgeon, this model could help him to keep in mind the topography of the CMOR, to improve the open book lesion management.

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“…25 Redman and Ross report on a transportable central-perfused cadaver model suitable for training in the battlefield environment on all tactical combat casualty care procedures including REBOA. 26 Using this model in different austere settings, Ross and Redman 27 tested two military emergency medicine physicians with no prior endovascular surgery exposure on vascular access and REBOA placement. Successful placement was accomplished in 86% of the models and percutaneous access was successful 54% of the time.…”

Section: Discussionmentioning

confidence: 99%

For debate: advanced bleeding control potentially saves lives in armed forces and should be considered

et al. 2019

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IntroductionAdvanced bleeding control options for truncal and junctional haemorrhage including resuscitative endovascular balloon occlusion of the aorta (REBOA) have been used in managing catastrophic bleeding. The primary aim is to report on potential indications for advanced bleeding control in combat casualties during the Dutch deployment in Uruzgan, Afghanistan, between August 2006 and August 2010. The secondary aim is to report on training methods for advanced bleeding control in (para)medical personnel.MethodsThe trauma registry from the Dutch role 2 enhanced medical treatment facility at Tarin Kowt, Uruzgan, Afghanistan, was used to analyse patients who sustained a battle injury with major haemorrhage. Furthermore, a comprehensive search was performed on training (para)medical personnel in advanced bleeding control.ResultsThere were 212 possible indications for advanced bleeding control with mortality of 28.8% (61/212). These possible indications consisted of 1.9% (4/212) junctional lower extremity injuries with a 75% (3/4) mortality rate, 59% (125/212) visceral vascular injuries with a mortality rate of 12.5% (26/125). The junctional and visceral injuries (n=129) were all potential indications for advanced bleeding control options, such as REBOA. Further 39.2% (83/212) casualties with central thoracic or neck injuries had a mortality rate of 38.6% (32/83). Based on an Abbreviated Injury Scale chest or abdomen score ≥461 indications for advanced bleeding control were identified. A 24-hour average of 8.8 packets of red blood cells, 4.2 packets of plasma and 1.9 packets of platelets was used to prevent exsanguination. The total out-of-hospital survival rate was 64% (39/61).ConclusionRetrospective analysis revealed 212 potential indications for advanced bleeding control with a mortality of 28.8% (61/212). Advanced bleeding control, such as REBOA, might have improved survival in approximately 61 of 212 casualties. Advanced bleeding control could be used as an adjunct to improve outcomes in major truncal or junctional haemorrhage in prehospital, remote settings and implementation should be considered. Vascular access training and REBOA placement for (para)medical military personnel should be explored in future research.

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A Novel Expeditionary Perfused Cadaver Model for Trauma Training in the Out-of-Hospital Setting

Cited by 10 publications

References 16 publications

Efficacy of a perfused cadaver model for simulated trauma resuscitation in advanced surgical skills training

Efficacy of a perfused cadaver model for simulated trauma resuscitation in advanced surgical skills training

Morphologic Study of the Corona Mortis Using the Simlife ® Technology

For debate: advanced bleeding control potentially saves lives in armed forces and should be considered

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