Development of a Cost-Effective Pediatric Intubation Task Trainer for Rural Medical Education

Abstract

Pediatric intubation and airway management (PIAM) is a life-saving, emergent procedure that is performed by a variety of healthcare practitioners. Securing the pediatric airway in a timesensitive fashion is a specialized skill that declines with lack of practice, leading to a precarious gap in clinical competency and healthcare delivery. However, current training models for PIAM, such as live animals, human cadavers, and simulators, are not adequately accessible or reliable due to their combination of high cost, unrealistic simulation, lack of standardization, and ethical concerns. Task trainers pose an ethically and fiscally sustainable training model for experiential learning through repetitive practice, which has been shown to dramatically improve trainee proficiency and confidence in performing high-acuity low-occurrence procedures such as pediatric intubation. This work aims to report the development process and initial validation evidence of a prototype cost-effective pediatric intubation task trainer that can be used for postgraduate education, especially in resource-challenged settings.

Applications of 3D printing in critical care medicine: A scoping review

“…Eight studies used 3D-printed models for preoperative planning and simulation of airway management in complex cases, five of which were in children. 17–24 Kavanagh and colleagues developed four models using 3D printing, including three direct-printed models made with different materials, including polylactic acid (PLA), acrylonitrile butadiene styrene and high-impact polystyrene, and a silicone model made from a 3D-printed cast. 18 These were tested by four otolaryngologists who concluded that the cast model was significantly better in terms of tissue characteristics, ease of tissue manipulation and overall accuracy.…”

“…18 Similar findings were also observed in two other studies reporting on the development of paediatric intubation simulation models involving the 3D printing of airways using black resin and red Ninjaflex (NinjaTek, Manheim, PA, USA). 17 , 19 Challenges included that the black colour used in the resin obscured the intubating view and while Ninjaflex was most comparable to soft tissue, it did not demonstrate the same yield as human tissue. 17 , 19 Single patient case studies were reported including complex cases of intubations involving children with Jarcho–Levin syndrome 20 and another with pulmonary alveolar proteinosis requiring single-lung ventilation.…”

“…17 , 19 Challenges included that the black colour used in the resin obscured the intubating view and while Ninjaflex was most comparable to soft tissue, it did not demonstrate the same yield as human tissue. 17 , 19 Single patient case studies were reported including complex cases of intubations involving children with Jarcho–Levin syndrome 20 and another with pulmonary alveolar proteinosis requiring single-lung ventilation. 21 Three other studies included printed models to plan and rehearse intubation preoperatively in complex cases related to a laryngectomy, tracheal stenosis and a head and neck cancer.…”

Educational use of animals in Europe indicates a reluctance to implement alternatives

“…Virtual reality simulators (Davies et al, 2013;Cagiltay et al, 2019), and full-and partial-body training simulators such as TraumaMan (Hall et al, 2014), SimMan 3G (Silverplats et al, 2016) or their low-cost alternative SurgeMan (Garcia et al, 2019), are providing the technology to aid fulfil training needs, evaluation of individual technical skills and team training on non-technical skills. 3D printing has also been implemented to create models for training, for example, cervical laminectomy or paediatric emergency procedures (Kovatch et al, 2020;Tanya and Dubrowski, 2020). These and other simulators are currently used to train surgeons to perform various routine operations in order to learn the appropriate skills for interventions on real patients (Tab.…”

The Development of an Intramuscular Injection Simulation for Nursing Students

“…On the contrary, synthetic models are good alternatives; however, they are costly, often lack realism, and do not provide the variability that is often needed for learning [4]. With the advent of additive manufacturing, such as 3D printing, we are now able to design and build inexpensive, realistic, and variable synthetic simulators [5][6][7][8]. Developing inexpensive IM injection simulations directed to nursing students will allow the aspiring nurses to become well acquainted with the skill before entering the clinical setting.…”