Evaluation of an Innovative Bleeding Cricothyrotomy Model

Abstract

ObjectivesEmergency medicine (EM) residents are required to perform a cricothyrotomy during training as per the Accreditation Council for Graduate Medical Education (ACGME) guidelines. Cricothyrotomy is a rare procedure, comprising 0.45% of emergency department airway management procedures. Procedural competence in utilizing a realistic trainer is of utmost importance. We have developed a cricothyrotomy trainer using a fused deposition modeling (FDM) three-dimensional (3D) printer and innovative bleeding tissue to enhance fidelity. We aim to evaluate the trainer’s realism.MethodsImplementation occurred during a difficult airway educational lab for EM residents in April 2018. Participants completed anonymous written surveys after performing a cricothyrotomy on the trainer. The survey evaluated the realism of the trainer and compared it to other available models by utilizing five-point visual analog scales (VAS). The participants rated their comfort level in performing the procedure pre- and post-educational lab on a five-point VAS. Demographic data included postgraduate year, prior clinical cricothyrotomy experience as a primary operator versus as an assistant, and previous trainer experience. The survey included open-response suggestions for trainer improvement. ResultsForty-three EM residents completed the survey (82.7%, 43/52). The mean realism rating of the trainer was 3.81 (95% CI = 3.54-4.1). The participants reported previous training on cadaver (62.8%, 27/43), porcine (46.5%, 20/43), and manikin (67.4%, 29/43) models prior to using this trainer. The bleeding cricothyrotomy trainer was rated higher than other models (4.45, 95% CI = 4.28-4.63). Participants noted improved comfort with performing the cricothyrotomy after the educational lab (average improvement of 1.23±0.75). Participants specifically commented on the realism of the bleeding and skin texture; however, they also recommended a reduction in the size of the cricothyroid membrane space. ConclusionThe innovative bleeding cricothyrotomy trainer has greater fidelity and reported superiority when compared to other commonly used nonbleeding models. This trainer provides a more advanced platform to teach an infrequent yet critical procedural skill to emergency medicine residents.

Evaluation of a Novel Three-Dimensional Emergency Cricothyrotomy Task Trainer

“…After surveying 31 clinicians who are involved in airway management, this study found that participants were more comfortable performing a cricothyrotomy after practicing on a simulator regardless of simulator type, porcine or the HiFEC model. This is in line with other studies finding that simulation-based task training improves the comfort and confidence of participants for such low-frequency, high-impact procedures [15,16]. The authors will continue to run more cricothyrotomy task training simulation programs for clinicians in the hospital's ED, as baseline comfort scores from this study were relatively low and simulation has proven to have a quantitative impact on comfort and confidence in approaching high stress situations.…”

The effect of teacher-made simulation moulage on learning cricothyrotomy skills in emergency medicine physicians

“…Hughes et al developed another kind of cricothyrotomy task trainer using a three-dimensional printer and pioneering bleeding tissue to improve the trainer's realism and fidelity and concluded that their task trainer has some superiority comparing to the other non-bleeding models, providing an advanced platform to teach the critical and yet infrequent skill of cricothyrotomy (22).…”

A Low-Cost Priapism Detumescence Simulator for Emergency Medicine Residents

“…All residents recommended this trainer for future use with medical students and residents, which we believe is likely due to the low incidence of the procedure, leading to an inability to maintain procedural competency. Task trainers are used for many other low incident procedures (i.e., cricothyrotomy [10][11][12] and lateral canthotomy [13,14]) within emergency medicine, so it is not surprising that this trainer was viewed favorably under similar circumstances. Like other important emergency procedures, competency for emergency medicine residents should be considered of utmost importance, especially for those who will practice in areas without prompt urological consultation.…”