Evaluation of a cricothyroidotomy simulator for teaching extreme surgical airway management with and without ultrasound.
Worthing Hospital, Western Sussex Hospitals NHS Foundation Trust, Dept of Anaesthesia and Intensive Care, Worthing
Background and Goal of study: NAP 4 showed that Anaesthetists surgical airway(SA) skills were poor and this was addressed by increased training via simulation. It became apparent that there were no models available in conditions where SA is most urgently needed, conditions like burns, anaphylaxis and angioneurotic oedema, where ultrasound(US) use has been suggested. A cost effective high fidelity model was developed for extreme SA so we decided to evaluate it to see if it could fill the gap in currently available training.1
Materials and Methods: We evaluated a cricothyroidotomy simulator modified to replicate soft tissue neck swelling by adding an ADAMgel (Aqueous Dietary fibre Antifreeze Mix gel) layer, as a training tool using an established questionnaire for validating SA models. 12 anaesthetists with simple SA training (3 consultants, 3 associate specialists, 3 senior and 3 junior trainees) performed surgical cricothyroidotomies without and with US guidance following a sonoanatomy demonstration in normal neck anatomy.(Fig. 1)
Results and Discussion: 12 participants enrolled in this study and all completed questionnaires for both airway scenarios. The results were universally positive.(Fig. 2) All participants felt this model was particularly useful in training more junior clinicians before they ‘practised’ on patients. Most participants reported increased confidence with equipment and performing the procedure on patients and felt it resembled real life.
Conclusions: This study demonstrates the utility of this extreme surgical airway model with and without US. It would lead to an increase in confidence and competence despite previous lack of exposure to these difficult and potentially life-threatening situations.
References
Willers J, Roberts A, Staniforth M, et al. Ultrasound assisted extreme surgical airway simulation. BMJ STEL. 2015;1:Suppl 2 A28.