Study ObjectivesThe primary objective of this study is to assess the feasibility of using a novel 3-D printed cricothyrotomy model with thick pre-tracheal soft tissue to train learners in performing ultrasound-guided cricothyrotomy on patients whose neck anatomy is difficult to palpate.MethodsThis is a single center, cross-sectional study in a level II urban teaching hospital. Study participants included emergency medicine (EM) residents and medical students who were present at simulation didactics. A 3-D model of the neck was designed to have thick pre-tracheal soft tissue such that palpation of the landmarks for performing cricothyrotomy was difficult or impossible. The 3-D printed neck and larynx was assembled with a 2 cm thick layer of ballistic gel overlying the larynx and then covered with artificial skin. Ultrasound gel was used inside the model to facilitate visualization of tracheal structures under ultrasound guidance. During a 40 minute simulation didactic session, a 10-minute lecture was given on how to use ultrasound guidance to identify anatomic landmarks for ultrasound-guided cricothyrotomy. Learners attempted to perform cricothyrotomy on the models using palpation alone, followed by a subsequent attempt using palpation and ultrasound guidance on identical unused models. Success or failure of correct bougie insertion location, as well as the time to tracheal bougie insertion was recorded. A pre- and post-workshop questionnaire was administered.ResultsA total of 17 learners participated including 10 EM residents and 7 medical students. All 17 learners filled out pre and post-workshop surveys. For EM residents, the median (IQR) time to bougie with palpation alone was 100 sec (65-148 sec) compared to palpation with ultrasound which was 95 sec (86-120 sec). For medical students, the median time to bougie with palpation alone was 132 sec (118-166 sec) compared to palpation with ultrasound which was 160 sec (106-181 sec). There were 3 failed attempts (all characterized by incorrect bougie insertion site) with palpation alone versus only 1 failed attempt (also with incorrect bougie insertion site) while using palpation and ultrasound.In response to their pre-workshop confidence in performing cricothyrotomy on a patient whose neck anatomy is difficult to palpate, 64.7% of learners were not confident at all, 23.5% were slightly confident, 5.9% were moderately confident, and 5.9% were very confident. After the workshop, 5.9% of learners were not confident at all, 29.4% were slightly confident, 52.9% were moderately confident, and 11.8% were very confident. 5.9% of learners were very likely to use ultrasound to assist in performing cricothyrotomy pre- workshop compared to 58.8% of learners post-workshop.ConclusionsThis novel 3-D printed cricothyrotomy model with thick pre-tracheal soft tissue provided a realistic training model for learners that successfully facilitated training in ultrasound guidance for cricothyrotomy and improved confidence in performing an ultrasound-guided cricothyrotomy on a patient with difficult airway and thick anterior neck tissue. There was a trend toward decreased failed cricothyrotomy attempts and decreased time to bougie insertion using palpation and ultrasound guidance compared to palpation alone.No, authors do not have interests to disclose Study ObjectivesThe primary objective of this study is to assess the feasibility of using a novel 3-D printed cricothyrotomy model with thick pre-tracheal soft tissue to train learners in performing ultrasound-guided cricothyrotomy on patients whose neck anatomy is difficult to palpate. The primary objective of this study is to assess the feasibility of using a novel 3-D printed cricothyrotomy model with thick pre-tracheal soft tissue to train learners in performing ultrasound-guided cricothyrotomy on patients whose neck anatomy is difficult to palpate. MethodsThis is a single center, cross-sectional study in a level II urban teaching hospital. Study participants included emergency medicine (EM) residents and medical students who were present at simulation didactics. A 3-D model of the neck was designed to have thick pre-tracheal soft tissue such that palpation of the landmarks for performing cricothyrotomy was difficult or impossible. The 3-D printed neck and larynx was assembled with a 2 cm thick layer of ballistic gel overlying the larynx and then covered with artificial skin. Ultrasound gel was used inside the model to facilitate visualization of tracheal structures under ultrasound guidance. During a 40 minute simulation didactic session, a 10-minute lecture was given on how to use ultrasound guidance to identify anatomic landmarks for ultrasound-guided cricothyrotomy. Learners attempted to perform cricothyrotomy on the models using palpation alone, followed by a subsequent attempt using palpation and ultrasound guidance on identical unused models. Success or failure of correct bougie insertion location, as well as the time to tracheal bougie insertion was recorded. A pre- and post-workshop questionnaire was administered. This is a single center, cross-sectional study in a level II urban teaching hospital. Study participants included emergency medicine (EM) residents and medical students who were present at simulation didactics. A 3-D model of the neck was designed to have thick pre-tracheal soft tissue such that palpation of the landmarks for performing cricothyrotomy was difficult or impossible. The 3-D printed neck and larynx was assembled with a 2 cm thick layer of ballistic gel overlying the larynx and then covered with artificial skin. Ultrasound gel was used inside the model to facilitate visualization of tracheal structures under ultrasound guidance. During a 40 minute simulation didactic session, a 10-minute lecture was given on how to use ultrasound guidance to identify anatomic landmarks for ultrasound-guided cricothyrotomy. Learners attempted to perform cricothyrotomy on the models using palpation alone, followed by a subsequent attempt using palpation and ultrasound guidance on identical unused models. Success or failure of correct bougie insertion location, as well as the time to tracheal bougie insertion was recorded. A pre- and post-workshop questionnaire was administered. ResultsA total of 17 learners participated including 10 EM residents and 7 medical students. All 17 learners filled out pre and post-workshop surveys. For EM residents, the median (IQR) time to bougie with palpation alone was 100 sec (65-148 sec) compared to palpation with ultrasound which was 95 sec (86-120 sec). For medical students, the median time to bougie with palpation alone was 132 sec (118-166 sec) compared to palpation with ultrasound which was 160 sec (106-181 sec). There were 3 failed attempts (all characterized by incorrect bougie insertion site) with palpation alone versus only 1 failed attempt (also with incorrect bougie insertion site) while using palpation and ultrasound.In response to their pre-workshop confidence in performing cricothyrotomy on a patient whose neck anatomy is difficult to palpate, 64.7% of learners were not confident at all, 23.5% were slightly confident, 5.9% were moderately confident, and 5.9% were very confident. After the workshop, 5.9% of learners were not confident at all, 29.4% were slightly confident, 52.9% were moderately confident, and 11.8% were very confident. 5.9% of learners were very likely to use ultrasound to assist in performing cricothyrotomy pre- workshop compared to 58.8% of learners post-workshop. A total of 17 learners participated including 10 EM residents and 7 medical students. All 17 learners filled out pre and post-workshop surveys. For EM residents, the median (IQR) time to bougie with palpation alone was 100 sec (65-148 sec) compared to palpation with ultrasound which was 95 sec (86-120 sec). For medical students, the median time to bougie with palpation alone was 132 sec (118-166 sec) compared to palpation with ultrasound which was 160 sec (106-181 sec). There were 3 failed attempts (all characterized by incorrect bougie insertion site) with palpation alone versus only 1 failed attempt (also with incorrect bougie insertion site) while using palpation and ultrasound. In response to their pre-workshop confidence in performing cricothyrotomy on a patient whose neck anatomy is difficult to palpate, 64.7% of learners were not confident at all, 23.5% were slightly confident, 5.9% were moderately confident, and 5.9% were very confident. After the workshop, 5.9% of learners were not confident at all, 29.4% were slightly confident, 52.9% were moderately confident, and 11.8% were very confident. 5.9% of learners were very likely to use ultrasound to assist in performing cricothyrotomy pre- workshop compared to 58.8% of learners post-workshop. ConclusionsThis novel 3-D printed cricothyrotomy model with thick pre-tracheal soft tissue provided a realistic training model for learners that successfully facilitated training in ultrasound guidance for cricothyrotomy and improved confidence in performing an ultrasound-guided cricothyrotomy on a patient with difficult airway and thick anterior neck tissue. There was a trend toward decreased failed cricothyrotomy attempts and decreased time to bougie insertion using palpation and ultrasound guidance compared to palpation alone.No, authors do not have interests to disclose This novel 3-D printed cricothyrotomy model with thick pre-tracheal soft tissue provided a realistic training model for learners that successfully facilitated training in ultrasound guidance for cricothyrotomy and improved confidence in performing an ultrasound-guided cricothyrotomy on a patient with difficult airway and thick anterior neck tissue. There was a trend toward decreased failed cricothyrotomy attempts and decreased time to bougie insertion using palpation and ultrasound guidance compared to palpation alone.