BACKGROUND: Surgical skills training is an integral component of the Advanced Trauma Life Support (ATLS) Course. Teaching techniques are continuously reevaluated and updated. Recognition of recurring technical errors in the performance of cricothyroidotomy in canine models prompted this comparison to the performance of the procedure in human cadavers. STUDY DESIGN: Thirty-three ATLS physician students performed cricothyroidotomy in canine models. Ten flight nurses performed a bimonthly surgical skills practicum on similarly prepared animals. Neck specimens were excised, fixed, and later mapped by the investigators. Subsequent courses used human cadavers obtained through the Wright State University School of Medicine Anatomical Gift Program. Cricothyroidotomy sites were mapped in situ. RESULTS: In the canine models, 47 necks with 52 attempted cricothyroidotomies were inspected and mapped by the investigators. Four specimens had multiple tracheotomy sites: three had two and one had three. If these multiple attempts are excluded from analysis, 13 of the 43 cricothyroidotomies in the canine models were misplaced (30.2%). Cricothyroidotomy placement in human cadavers was correct in 27 of 28 attempts (96.4%). CONCLUSIONS: It is imperative that cricothyroidotomy, a high-risk procedure, be taught in an appropriate model to best prepare students to perform it in a life-saving situation. Placement accuracy in canine models is low. Alternative models for teaching this procedure should be considered.
BACKGROUND: Surgical skills training is an integral component of the Advanced Trauma Life Support (ATLS) Course. Teaching techniques are continuously reevaluated and updated. Recognition of recurring technical errors in the performance of cricothyroidotomy in canine models prompted this comparison to the performance of the procedure in human cadavers. STUDY DESIGN: Thirty-three ATLS physician students performed cricothyroidotomy in canine models. Ten flight nurses performed a bimonthly surgical skills practicum on similarly prepared animals. Neck specimens were excised, fixed, and later mapped by the investigators. Subsequent courses used human cadavers obtained through the Wright State University School of Medicine Anatomical Gift Program. Cricothyroidotomy sites were mapped in situ. RESULTS: In the canine models, 47 necks with 52 attempted cricothyroidotomies were inspected and mapped by the investigators. Four specimens had multiple tracheotomy sites: three had two and one had three. If these multiple attempts are excluded from analysis, 13 of the 43 cricothyroidotomies in the canine models were misplaced (30.2%). Cricothyroidotomy placement in human cadavers was correct in 27 of 28 attempts (96.4%). CONCLUSIONS: It is imperative that cricothyroidotomy, a high-risk procedure, be taught in an appropriate model to best prepare students to perform it in a life-saving situation. Placement accuracy in canine models is low. Alternative models for teaching this procedure should be considered.
Authors: Luis Teodoro da Luz; Bartolomeu Nascimento; Homer Tien; Michael J Kim; Avery B Nathens; Savvas Vlachos; Elon Glassberg Journal: Can J Surg Date: 2015-06 Impact factor: 2.089