Assessment of the percutaneous dilatational tracheostomy technique in experimental manikins and canine cadavers

Abstract

Objective: To evaluate procedure time, ease of placement, and complication rates of percutaneous dilatational tracheostomy (PDT) compared to surgical tracheostomy (ST) in canine cadavers. Design: Randomized crossover experimental manikin and cadaver study involving 6 novice veterinary students. Setting: University teaching hospital. Animals: Canine tracheostomy training manikin, 24 canine cadavers. Interventions: None. Measurements and Main Results: For training, each student performed 10 PDT and 10 ST procedures on a training manikin, followed by 2 PDT and 2 ST procedures on a canine cadaver. After each training procedure, feedback from bronchoscopy and observers was provided. Final PDT and ST tube placements using new equipment were performed in unused cadavers. Placements were timed, ease of placement was scored using visual analog scales (VAS, 0-10 cm), and complications were assessed by two independent observers using ordinal scales (0-3). Cadaver tracheas were explanted postprocedure to evaluate anatomical damage scores (0-3). Procedure time and VAS scores for PDT and ST procedures were analyzed using mixed-effects linear models, accounting for student, technique, and procedure number with post hoc pairwise comparisons. Data are presented as median (range). For the final cadaver placement, there were no significant differences in placement time (300 seconds [230-1020] vs 188 seconds [116-414], P = 0.210), ease of placement (3.8 cm [2.1-5.7] vs 1.9 cm [0-4.7], P = 0.132), anatomical damage score (1 [0-2] vs 0 [0-1], P = 0.063), or equipment complications score (0 [0-1] vs 0 [0-0], P = 1.000) between PDT and ST, respectively.Conclusions: These data suggest that PDT can be performed as quickly, as easily, and as safely as ST in a canine cadaver by novice veterinary students following manikin training. Additional studies will be required to determine if these findings can be translated into veterinary clinical practice. K E Y W O R D Sanatomic models, complications, manikin training, trachea, upper airway obstruction

Data_Sheet_2.PDF

“…It is possible the authors may have somehow influenced the TT procedure which resulted in longer times. However, a similar study, also using veterinary students as participants (15), found that the standard TT procedure had a median time of 188 s following 10 training attempts on mannikins and one training attempt on a cadaver. The abbreviated TT in this study took a median time of 95.7 s over all attempts, indicating that this was taught in a way to maximise speed.…”

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“…Sixty seconds was estimated from the author's experience and similar studies (18)(19)(20). The TT time estimate was based on the study by Pardo et al (15), less the expected time saved with the abbreviated technique. Analyses were conducted in R Statistical program software 3 and Stata version 16.1 4 .…”

Data_Sheet_1.PDF

“…Damage scores were adapted from a similar veterinary study (15). A score was given for each injury ( Table 3).…”

“…The students then completed a survey which included a visual analogue scale (VAS), scored from 0 to 10 with 0 being "the easiest procedure you can think of " and 10 being "the most technically challenging procedure you can imagine." This method was adopted from previous similar studies (15,16). Additionally, students were also asked which technique they would select in practice if faced with a CICO event.…”

“…A video demonstrating this technique can be found in the Supplementary Materials. The TT technique was performed as the standard comparator and was adapted from several sources (8,15,17). As speed of placement was the primary objective, an abbreviated procedure was developed, colloquially known as a "slash" TT.…”