Kei Jonathan, Mebust Donald P, Duggan Laura V
Department of Emergency Medicine, Kaiser Permanente Medical Center, San Diego, California.
Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada.
J Emerg Med. 2019 Apr;56(4):426-430. doi: 10.1016/j.jemermed.2018.12.023. Epub 2019 Jan 23.
Surgical cricothyrotomy is a rare procedure but it must be mastered by any physician who is involved in advanced airway management. Lack of experience and practice, the high-stress nature of a "can't intubate, can't oxygenate" emergency, and the unavailability of realistic simulators all contribute to physician hesitance and inaptitude while employing cricothyrotomy during difficult and failed airways. The REAL CRIC Trainer was created to alleviate some of the barriers surrounding a surgical airway. It is designed to provide the user an affordable, easy to replicate, reusable, and extremely realistic experience in cricothyrotomy to prepare for this rare event.
The REAL CRIC Trainer uses a 3-dimensional printed tracheal model that is covered with pork belly skin, replicating human neck tissue. Red dyed normal saline is connected to the pork belly using intravenous tubing to simulate bleeding as an incision is made into the porcine skin. A bag-valve-mask connected to an endotracheal tube and to the trachea model will simulate breathing and replicate the puff of air experienced as the cricothyroid membrane is pierced with a scalpel. This simulator is cost effective and easy to replicate. Detailed step-by-step instructions are provided so that physicians working in any specialty involved in advanced airway management can easily recreate this trainer.
This simulator makes it practical for physicians in a variety of clinical settings to incorporate its use into regular practice sessions, thereby assuring that physicians are ready to perform an emergent cricothyrotomy if necessary.
外科环甲膜切开术是一种罕见的操作，但任何参与高级气道管理的医生都必须掌握。由于缺乏经验和实践、“无法插管、无法给氧”紧急情况的高压力性质以及缺乏逼真的模拟器，医生在困难气道和气道插管失败时进行环甲膜切开术时会犹豫不决且操作不当。REAL CRIC训练器的发明是为了减轻围绕外科气道的一些障碍。它旨在为用户提供一种价格实惠、易于复制、可重复使用且极其逼真的环甲膜切开术体验，为应对这一罕见情况做好准备。
REAL CRIC训练器使用一个三维打印的气管模型，该模型覆盖有猪肚皮肤，模拟人类颈部组织。红色染色的生理盐水通过静脉输液管连接到猪肚，以在切开猪皮时模拟出血。一个连接到气管导管和气管模型的袋阀面罩将模拟呼吸，并复制用手术刀刺破环甲膜时所体验到的一股气流。这个模拟器性价比高且易于复制。提供了详细的分步说明，以便参与高级气道管理的任何专科的医生都能轻松重现这个训练器。
这个模拟器使各种临床环境中的医生将其使用纳入常规练习成为现实，从而确保医生在必要时能够随时进行紧急环甲膜切开术。
