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Cricothyroidotomy Training Model Using Supplies in Austere Deployed Environment
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DOI：10.1093/milmed/usag121.png)
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Abstract
En 中文
Introduction: Cricothyroidotomy is a rarely performed, but lifesaving procedure. It is imperative that surgeons and the medical teams they work with can execute the steps required to successfully perform a cricothyroidotomy. As a procedure that is dependent on tactile feedback and expeditious execution, surgical teams require training models that can meet these needs for successful performance of a cricothyroidotomy when met with a patient who cannot intubate and cannot ventilate. Cadaveric, animal, and adequate synthetic training models are preferred but are not commonly available in deployed environments. Herein, we present a simple, inexpensive, and reproducible cricothyroidotomy training model built using supplies available in any hospital, including deployed medical facilities. Materials and Methods: Cricothyroidotomy models were built using spirometer tubing, rolls of tape, and latex roll bandaging. A voluntary training session was held at a deployed military medical facility and was open to all hospital personnel and coalition force members. Participating members completed an anonymous survey detailing their level of experience performing cricothyroidotomy as well as their self-assessment of knowledge of steps, instruments, and overall confidence performing cricothyroidotomy on a 5-point Likert scale. A brief didactic session was held reviewing steps of the cricothyroidotomy, then each participant performed a timed cricothyroidotomy on the model and completed a post-training survey documenting level of confidence with the procedure post-training and an overall assessment of the model using a 5-point Likert scale. Participants repeated a timed cricothyroidotomy on the same model 4 weeks later. Pre and post-training confidence levels were compared using the Wilcoxon signed-rank test; time to cannulation between first and second attempts 4 weeks later were compared using the paired samples t test. This study underwent formal IRB review and was granted exempt status, as it did not involve patients and collected anonymous survey data from voluntary participants. Results: Thirty-two soldiers, including American healthcare professionals and coalition force medics, completed the training. Self-assessment of confidence in performing cricothyroidotomy on a 5-point Likert scale improved from a mean of 2.78 to 3.63 pre and post-training, respectively (P < .005). Mean time to cannulation improved from a mean of 101.6 +/- 60.7 seconds on first attempt to 62.6 +/- 24.8 seconds on second attempt 4 weeks later. Mean overall rating of usefulness of the model by participants was 4.77 on a 5-point Likert scale, indicating a perception that the model was overall very useful for training. Conclusion: A simple, portable, and inexpensive cricothyroidotomy training model can be built with common hospital supplies available even in austere deployed environments. This model is suitable for hands-on practice and can increase level of confidence as well as speed in performing cricothyroidotomy. The realism of the model is limited by the simplicity of the materials, however, it is adequate in instances where cadaver and animal tissue are unavailable. Future study could evaluate equally portable and inexpensive training options for deployed soldiers, including 3D models.
Keywords:
CRICOTHYROTOMY
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