Cricothyrotomy Simulator with Computational Skill Assessment for Procedural Skill Training in the Developing World

Abstract

Objectives: Cricothyrotomy is a life-saving procedure performed when an airway cannot be established through less invasive techniques. The goals of this study were to 1) design and build a low-cost simulator that teaches essential anatomy, and 2) provide a method of data collection for performance evaluation and guided instruction. Methods: The design of the simulator was optimized for materials that are low-cost and widely available and for accurate anatomical landmarks. It was designed to electronically record instrument contact with critical anatomical locations throughout the procedure. Three simulators were constructed, and data were collected during 20 procedures performed by participants of varying surgical experience level. Surveys were completed by all participants to assess the perceived quality of the simulator. Three experts graded the recorded procedures by completing an Objective Structured Assessment of Technical Skills (OSATS) survey. Results: A simulator was designed and built. Procedural data of 20 subjects were collected. The survey data showed the majority of participants answered “moderate” or “very” on questions related to 1) anatomical accuracy (85%), 2) realism (50%), 3) improved understanding of procedure (65%), and 4) useful for practice (85%). The OSATS data correlated with task time. Conclusions: A cricothyrotomy simulator for use in a low-resource environment was designed and produced. It collects data that can be used for performance evaluation and instruction. These were analyzed against OSATS data. A study of 20 subjects, 12 of whom were experts, demonstrated that it was realistic, anatomically accurate, and useful for practice and improving procedure knowledge.

Training on a virtual reality cricothyroidotomy simulator improves skills and transfers to a simulated procedure

“…Currently, learning and maintaining the skill is done by practicing on cadavers, animal models, manikins or small benchtop models. [2][3][4][5][6][7][8][9][10][11][12] Due to ethical issues in using animals, 99% of the advanced trauma life support (ATLS) courses in the USA and all of the courses in Canada now use the American College of Surgeons (ACS)-approved manikin-based simulators. 13 The main limitations of manikin-based simulators are in providing a highfidelity simulation with variations that are routinely seen in clinical cases.…”

Crowd-sourced assessment of surgical skills in cricothyrotomy procedure

“…After Institutional Review Board approval (University of Washington, IRB Number = 18,192), 26 participants comprised of medical students, residents, and attending surgeons from the University of Washington Department of Otolaryngology-Head and Neck Surgery, performed a cricothyrotomy procedure using a low-cost simulator [5]. The simulator was designed and developed in the BioRobotics Lab, University of Washington.…”

“…A cricothyrotomy simulator was chosen as the test platform [5]. This procedure consists of multiple surgical subtasks such as making an incision with scalpel, spreading the tissue with forceps, retracting tissue with a cricoid hook, and inserting an endotracheal tube.…”

Feasibility of Remote Landmark Identification for Cricothyrotomy Using Robotic Palpation

“…Specifically, there are research works that investigate the means of improving the performance for Cricothyrotomy that do not involve robot assistance. These attempts focus on improving cricothyrotomy training program either by introducing the simulators with some real-time feedback on performance [4], [14] or by filling up the gaps found in the existing procedural skill training programs [15]. These approaches demand the emergency physicians to be present on the site which may be prohibitively dangerous in certain scenarios of the battlefield and disaster rescue.…”

“…Failure comes with a risk of severing the cricothyroid arteries, tearing the tracheal cartilage, damaging the trachea, or creating a false passage [2], [3]. The reported complication rates of the emergency cricothyrotomy range from 10% to 40%, primarily due to inaccurate landmark identification [3][4][5][6]. Cricothyrotomy is performed in life-or-death situations and when other airway management options are contraindicated.…”