Background Performing emergency cricothyriodotomy is an integral part of difficult airway management, and this technique is widely taught via simulation using animal, homemade surgical and commercial models. Landmarks for these procedures are usually easily palpable, but not in some of the extreme conditions where surgical airway is most urgently needed, namely burn injuries, anaphylaxis and angioneurotic oedema. Recent research showed the value of ultrasound in performing cricothyroidomies on cadavers,1 and could be even more helpful in the mentioned extreme situations. As there is currently no airway model simulating these conditions,2 or for utilising ultrasound, we sought to remedy this.
Methodology We integrated the design of an award winning cricothyroidotomy simulator3 with a model of the neck for teaching ultrasound guided regional anaesthesia,4 and modified it to simulate neck swelling by increasing the thickness of the ADAMgel (Aqueous Dietary fibre Antifreeze Mix gel) layer representing pre-laryngeal tissue. This entailed manufacturing a larynx and airway phantom attached to a lung analogue and inserted in an airway manikin with appropriate thickness covering decorated to portray relevant pathology. Additionally a pad of ADAMgel was cast to demonstrate the effect of subcutaneous swelling on the normal ultrasound appearance of airways in neck oedema on a live model.
Results The neck swelling looked and felt realistic. Anatomical landmarks were visible on ultrasound allowing localising of cricothyroid membrane. Airway localisation by air aspiration or free fluid flow and imaging were possible. Needle and surgical cricothyroidotomy, with or without ultrasound, were true to life as well. Scanning the neck of a live model with and without the oedema pad illustrated landmarks for comparison. Total costs if utilising theatre discards should be <£3, and is recyclable.
Conclusion This extreme surgical airway model enable extreme surgical airway simulation, ultrasound assisted or not, in scenarios and procedural simulations.
Curtis K, Ahern M, Dawson M, Mallin M. Ultrasound-guided, Bougie-assisted cricothyroidotomy: a description of a novel technique in cadaveric models. Acad Emerg Med 2012;19:876–879
Howes T, Lobo C, Kelly F, Cook TM. Rescuing the obese or burned airway: are conventional training manikins adequate? A simulation study. Br J Anaesth. 2015;114(1):136–42
Akrimi S, Singh N, Willers J, Malley T, Bygrave C, Uncles D. A new cost-effective model developed for training in cricothyroidotomy. Anaesthesia 2014;69:31
Willers J, Crossland C. Creating a kinetic ultrasound phantom for Interscalene Block. World Congress of Regional Anaesthesia 2014-0237
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