Evaluating the fidelity of a novel part-task trainer for emergency front of neck access training.

Abstract

In 2015, the British Difficult Airway Society (DAS) revised its guidelines for managing an unanticipated difficult airway, recommending surgical cricothyroidotomy as the new standard emergency front of neck access (FONA).1 In the UK, the 4th National Audit Project of the Royal College of Anaesthetists recommended anaesthetists to undergo frequent FONA training using simulation.2 Fidelity in simulation has physical, functional and psychological components,3 and we feel that the Crico-Trainer (Frova; VMB Medical, Newcastle, UK), currently used in our department, could be improved. A prestudy survey (n=15) of attending (consultant) anaesthetists identified ‘ideal manikin qualities’. This confirmed that important features were high-fidelity feel of: tissue (80.0%), scalpel incision (86.7%) and surface (80.0%). The ability to intubate (60.0%), haemorrhage (46.7%) and mimic an impalpable cricothyroid membrane (46.7%) were also considered important. The Frova was deemed to lack realistic tissue planes (80.0%), component feel (66.7%) and haemorrhage (46.7%). The aim of this study was to develop and evaluate our own trainer, focusing on improved fidelity. We designed and constructed our part-task trainer (figure 1) using a wooden base, proprietary reusable plastic ‘larynx/trachea’ and a novel disposable ‘neck tissue’ prosthesis, which feels realistic and bleeds when cut. The neck was fabricated from a viscoelastic polymer (Akton; Action Products, Leek, UK) coated in acrylic paint (Daler-Rowney, Bracknell, UK) and …