Making the Cut: Implementing a Low Cost, Low Fidelity Simulation Model for Teaching Emergency Thoracotomy Procedure

Abstract

Emergent thoracotomy is a rare but high-stakes procedure for trauma patients. Emergency medicine residents are expected to perform this procedure after graduation, but few get the opportunity to perform it, leading to suboptimal performance and patient morbidity and mortality. Previous low-cost thoracotomy trainers revolve around modifying an existing costly thoracotomy task trainer or bear limited resemblance to actual landmarks and anatomy. This study attempts to bridge this gap by creating a low-cost model with supplies found at most home improvement/craft stores that is more anatomically accurate. We constructed a low fidelity model, which residents ultimately found to be helpful in mastering this rare procedure, and after the training session, they reported a greater level of comfort and familiarization with the procedure.

Development of a Low-Cost, High-Fidelity, Reusable Model to Simulate Clamshell Thoracotomy

“…6,7 Additionally, CST is classified as a High Acuity Low Occurrence (HALO) procedure, meaning it is a ‘high-stakes’ procedure with very limited opportunities for observation or practice. 2,8,9…”

“…6,7 Additionally, CST is classified as a High Acuity Low Occurrence (HALO) procedure, meaning it is a 'high-stakes' procedure with very limited opportunities for observation or practice. 2,8,9 Given these factors, it is important to explore other avenues by which clinicians may become comfortable with CST. While options for simulation of CST do exist, commercially available models are expensive and this can inhibit widespread use.…”

“…While options for simulation of CST do exist, commercially available models are expensive and this can inhibit widespread use. 7,8,10 Cadaveric teaching has also been suggested as a solution; however this is limited by the inability to perform certain interventions on cadavers (e.g., haemorrhage control), 2,9 the need for specialist facilities, and that the embalming of tissue can limit realism. Animal models, while less expensive and requiring less specialist resources, have limited benefit due to anatomical limitations.…”

Simulation Training in a Lower Middle-Income Country: Supporting a New Center and Developing Low-Cost Models for Critical Skill Acquisition

“…Commercially available simulation training models for both procedures are often expensive and lack interactive elements. Low-cost simulators reported by other authors for ultrasound-guided pericardiocentesis and open thoracostomy have shown promising results, highlighting the value of low-cost simulators for teaching these high-acuity procedures [ 6 - 10 ]. Lord et al’s 3D-printed low-cost pericardiocentesis model was well-received by emergency medicine residents in the United States, with 92% of the residents “strongly agreeing” that the models effectively mimicked the clinical scenario [ 6 ].…”

Development of a Gastight Thoracotomy Model for Investigation of Carbon Dioxide Field-Flooding Efficacy

“…In general, commercial medical training models are no option for CO 2 studies, because they are not designed to be gastight and are expensive. Thus, we took inspiration from some low-cost and "home-made" alternatives that have been developed, especially for student training in emergency thoracotomy [10][11][12]. We dedicated this technical report to give a detailed description of a thoracotomy model that is specifically designed for CO 2 field-flooding studies and can also be used for training other surgical procedures.…”