Huang Jeffrey, Licatino Lauren K, Ocariz Santiago, Warner Paul A, Sims Charles R
J Educ Perioper Med. 2021 Jul 1;23(3):E670. doi: 10.46374/volxxiii_issue3_sims. eCollection 2021 Jul-Sep.
Cricothyrotomy is a final recourse for salvaging a difficult airway, yet most anesthesiology providers have little training, exposure, or comfort with the procedure. Pig tracheas are frequently used for training, but are single use and require special handling and storage. Other simulation models, such as mannequins and cadavers, are costly. Advances in 3dimensional (3D) printing have improved accessibility and decreased costs. This research project sought to determine whether an inexpensive 3D-printed task trainer was noninferior to pig tracheas for teaching surgical cricothyrotomy skills.
Anesthesiology residents were enrolled in an institutional review board-exempted, unblinded, randomized, controlled, single-institution, noninferiority trial. Participants were trained in the scalpel-finger-bougie technique for surgical cricothyrotomy. Participants were randomized to practice 5 repetitions on either a pig trachea or the 3D model and were assessed on time to cricothyrotomy completion on a pig trachea before and after practice.
Demographic characteristics of the 25 workshop attendees were similar between study arms. Overall mean (SD) improvement in speed was 9 (12) seconds ( = .001). Postpractice times were similar between groups (analysis of covariance estimated difference of -0.1 seconds [95% confidence interval, -9.4 to 9.2]; = .55). The 3D model was noninferior to the pig trachea at the prespecified noninferiority margin of 10 seconds ( = .017).
The 3D model was noninferior to pig tracheas for improving the time to completion of a surgical cricothyrotomy. A 3D-printed model offers a viable alternative to pig tracheas for emergency airway simulation that is inexpensive, reusable, and readily modified to simulate challenging airway anatomy.
环甲膜切开术是挽救困难气道的最终手段，但大多数麻醉医生对该操作的培训、接触和熟练程度都很低。猪气管常用于培训，但为一次性使用，且需要特殊处理和储存。其他模拟模型，如人体模型和尸体，成本很高。三维（3D）打印技术的进步提高了可及性并降低了成本。本研究项目旨在确定一种廉价的3D打印任务训练器在教授外科环甲膜切开术技能方面是否不劣于猪气管。
麻醉科住院医师参加了一项经机构审查委员会豁免、非盲、随机、对照、单机构、非劣效性试验。参与者接受了手术刀-手指-探条技术的外科环甲膜切开术培训。参与者被随机分配在猪气管或3D模型上练习5次，并在练习前后对在猪气管上完成环甲膜切开术的时间进行评估。
两个研究组中25名参加培训者的人口统计学特征相似。速度的总体平均（标准差）提高为9（12）秒（P = .001）。两组练习后的时间相似（协方差分析估计差异为-0.1秒[95%置信区间，-9.4至9.2]；P = .55）。在预先设定的10秒非劣效性界限下，3D模型不劣于猪气管（P = .017）。
在缩短外科环甲膜切开术完成时间方面，3D模型不劣于猪气管。3D打印模型为紧急气道模拟提供了一种可行的替代猪气管的方案，它价格便宜、可重复使用，并且可以很容易地进行修改以模拟具有挑战性的气道解剖结构。
