Teaching Lifesaving Procedures: The Impact of Model Fidelity on Acquisition and Transfer of Cricothyrotomy Skills to Performance on Cadavers

Abstract

To the Editor: Using high- and low-fidelity simulators, Friedman et al.1 describe teaching cricothyrotomy using the Seldinger technique of the Melker set (Cook, Bloomington, IN). The authors demonstrate, as do others,2 that this method is slow (pretest 240 s and 260 s in the low- and high-fidelity training groups, respectively, posttest 140 s and 120 s).1 The new Melker kit, with preloaded dilator, may improve performance, but we believe that trainees should also be taught surgical cricothyrotomy, which with instruction can be achievable in as little as 30 s.3 The authors acknowledge the lack of a control group, without which it is difficult to ascribe improvement to practice on manikins. Improvements may have resulted from exposure to an instructional video, equipment familiarity, or advance preparation for a posttest. Having used the SimMan (Laerdal, Kent, UK) to teach cricothyrotomy, we would argue with the assigned “high fidelity” characteristics. Perhaps, the distinction between the two manikins in Friedman’s study is not so much one of fidelity but more one of expense. Arguably, a better high-fidelity comparison would have been with cadavers. Charlotte R. Soulsby Gareth Kessell, MBChB, MRCP, FRCA Department of Anaesthesia James Cook University Hospital Middlesbrough, UK [email protected]