Emergency Surgical Airway Simulator (ESAS): A State-of-the-art Task Trainer Combining 3D-printed Larynx-trachea Model and Innovative Approaches for Cricothyroidotomy Training

Abstract

Cricothyroidotomy is an emergency surgical airway procedure which has been incorporated into an Advanced Surgical Trauma Course (ASTC) co-organized by Department of Surgery and Multi-disciplinary Simulation and Skills Centre. In order to enhance training quality and safety, our center proposed to change the use of pig larynx-trachea to human-data generated 3D-printed models, and further invented a more intricate one named Emergency Surgical Airway Simulator (ESAS) recently. We combined 3D-printing knowledge with other innovative technologies at affordable price to mimic the life-saving procedure as well as observable effects, including i) bleeding upon skin incision, ii) air gushing-out during cricothyroid membrane incision, iii) cheat rise and iv) fogging within endotracheal tube on bagging. A multi-disciplinary expert panel formulated a self-report “Scales of Emergency Surgical Airway Simulator (SESAS-17)” made up of 5-point Likert scales, examining the extent to which the simulator achieved satisfactory usability, in terms of Design, Realism (sub-categorized by “Physical”, “Procedural”, “Functional” fidelity), Functionality, Efficacy, Appraisal, and Safety. Six general surgeons and 3 Accident and Emergency (A&E) Physicians who performed cricothyroidotomy in a trial reflected on the immersive experience with positive feedback. For assessment and education purposes, this simulator can enhance psychomotor skills and cognitive preparation required for emergency airway management through deliberate practice on cricothyroidotomy alone, and, non-technical skills through scenario-based hybrid simulation in the near future.

Keywords: Innovation, 3D-printing, Larynx-trachea Model, Surgical Airway Simulator, Emergency Training, Cricothyroidotomy