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October 19, 2019
10/19/2019 3:00:00 PM - 10/19/2019 4:30:00 PM
Room W206ABC
A Low Cost Task Trainer for Front-of-neck Emergency Airway Access Training
Samsun Lampotang, Ph.D., Cameron R. Smith, M.D., Lauren C. Berkow, M.D., Nikolaus Gravenstein, M.D., Anthony Destephens, M.Eng., Felipe Urdaneta, M.D.
University of Florida, Gainesville, Florida , United States
Disclosures: S. Lampotang: None.C.R. Smith: None.L.C. Berkow: None.N. Gravenstein: None.A. Destephens: None.F. Urdaneta: None.
Introduction:Front-of-neck techniques to secure a difficult airway in a cannot intubate - cannot oxygenate scenario are the final common pathway in the ASA and other difficult airway algorithms. Since emergent cricothyrotomies are not commonly performed, anesthesiologists are often hesitant to use them and unfamiliar with the equipment that is necessary or available. Simulation can be highly efficacious to familiarize anesthesiologists with the tools and techniques at their disposal during airway emergencies. Unfortunately, purpose-built simulators for front-of-neck airway access training are scarce, expensive, and require the ongoing purchase of relatively high-cost consumables. Likewise, there is a scarcity and high cost associated with the use of cadavers for such training. By modifying the design originally proposed by Varaday et al (2004), we have implemented a low cost, easy to produce and sufficiently realistic simulation task trainer to help fill this gap.Assembly:A standard intubation simulator (e.g., Laerdal) can be quickly and easily modified to be repeatedly used for front-of-neck airway access training without compromising its integrity. We use a 10cm section of corrugated tubing sourced from a ventilator circuit to mimic cartilaginous rings. Into this tubing, we place heavy a tubing diameter width paper strip cut from a file folder to simulate the posterior tracheal membrane, which is free of cartilaginous rings. We place behind the tubing a 4” section of 1-1/4” diameter PVC pipe cut longitudinally to protect the intubation mannequin from inadvertent damage from overzealous knife blade or needle placement. Over the corrugated tubing, a layer of silicone compound made from Ecoflex 00-30 Platinum Silicone Rubber Compound is placed to simulate skin and soft tissue. Once assembled this unit can be secured to the exterior of an intubation training mannequin using self-adhesive dressing, e.g., Coban® and one for the ribs of the ventilator tubing marked and designated as the ‘cricoid ring’. The simulator is now ready for use. Results:To date, this simulator has been used during difficult airway exercises at the University of Florida Center for Simulation, Safety & Advanced Learning Technologies with over 200 anesthesiologists to practice multiple techniques for front-of-neck emergency airway access. This task trainer lends itself well to practice the Difficult Airway Society’s new preferred front of neck access using a tube exchanger vs. a Seldinger-style technique. Response to the trainer has been universally positive across the entire experience spectrum, from medical students through experienced anesthesiologists.Conclusions:We believe that the task trainer we describe is easy and inexpensive to make. Additionally, deliberate practice of front-of-neck emergency airway access techniques provided by the task trainer helped to increase familiarity and confidence with performing such techniques, as illustrated by unsolicited feedback from a trainee informing us 2 weeks post-training that our training helped provide a good outcome in an actual difficult airway requiring cricothyrotomy.$$graphic_{A607E898-F767-491D-AD08-C9349455C5EB}$$$$graphic_{A4A24162-3818-4EF2-8A8B-8ED054423165}$$
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