Simulation Manikin Research Articles

Release velocity ImprovemenT with a new Metronome guIding chest COmpressions: The RITMICO simulation study.

Outcomes of out-of-hospital cardiac arrest vary significantly, often due to the quality of cardiopulmonary resuscitation (CPR) provided. Automated real-time feedback devices have been explored to enhance CPR skills, but few devices currently ensure proper chest recoil. This study aimed to assess whether a double-click metronome could improve chest compressions (CC) metrics and particularly CC release velocity (CCRV) during CPR manikin simulation. We developed and tested a double-click metronome for CPR, where the first click signals the compression and the second click marks the end of chest release. We performed a multicenter non-blinded, randomized, controlled trial including volunteers with different levels of CPR expertise. Three CC metrics-depth, rate, and CCRV-were measured using an automated external defibrillator equipped with pads for CPR quality analysis. 503 volunteers participated in the study, with 54% being male and a mean age of 34±12years. The median CCRV and CC depth achieved with the double-click metronome were significantly higher compared to the standard metronome (median difference 6mm/s, IQR-15.2, 28.5, +1.5%, p<0.001; median difference 0.1cm, +2.5%, IQR -0.1, 0.4, p<0.001). The double-click metronome led to significant improvements in CC depth and CCRV across all volunteer categories, with the greater effect observed in first responders and in non-specialized healthcare personnel. Compared to a standard metronome, the double-click metronome significantly enhances CPR quality. If further validated in real resuscitations, this new audio prompt could be a valuable tool for integration into devices designed for out-of-hospital cardiac arrest resuscitation, as well as a training tool to improve CPR quality.

Evaluation of the Effectiveness of Advanced Technology Clinical Simulation Manikins in Improving the Capability of Australian Paramedics to Deliver High-Quality Cardiopulmonary Resuscitation: Pre- and Postintervention Study.

Emergency medical services attend out-of-hospital cardiac arrests all across Australia. Resuscitation by emergency medical services is attempted in nearly half of all cases. However, resuscitation skills can degrade over time without adequate exposure, which negatively impacts patient survival. Consequently, for paramedics working in areas with low out-of-hospital cardiac arrest case volumes, ambulance services and professional bodies recognize the importance of alternative ways to maintain resuscitation skills. Simulation-based training via resuscitation manikins offers a potential solution for maintaining paramedic clinical practice skills. The aim of the study is to examine the effectiveness of advanced technology clinical simulation manikins and accompanying simulation resources (targeted clinical scenarios and debriefing tools) in improving the demonstrable capability of paramedics to deliver high-quality patient care, as measured by external cardiac compression (ECC) performance. A pre- and postintervention study design without a control group was used. Data were collected at the start of the manikin training forum (baseline), immediately following the training forum (time 2), and 6 to 11 months after the training forum (time 3). The study was conducted with paramedics from 95 NSW Ambulance locations (75 regional locations and 20 metropolitan locations). Eligible participants were paramedics who were employed by NSW Ambulance (N=106; 100% consent rate). As part of the intervention, paramedics attended a training session on the use of advanced technology simulation manikins. Manikins were then deployed to locations for further use. The main outcome measure was an overall compression score that was automatically recorded and calculated by the simulator manikin in 2-minute cycles. This score was derived from compressions that were fully released and with the correct hand position, adequate depth, and adequate rate. A total of 106 (100% consent rate) paramedics participated, primarily representing regional ambulance locations (n= 75, 78.9%). ECC compression scores were on average 95% or above at all time points, suggesting high performance. No significant differences over time (P>.05) were identified for the overall ECC performance score, compressions fully released, compressions with adequate depth, or compressions with the correct hand position. However, paramedics had significantly lower odds (odds ratio 0.30, 95% CI 0.12-0.78) of achieving compressions with adequate rate at time 3 compared to time 2 (P=.01). Compressions were of a slower rate, with an average difference of 2.1 fewer compressions every minute. Despite this difference in compression rate over time, this did not cause significant detriment to overall ECC performance. Training and deployment of simulator manikins did not significantly change paramedics' overall ECC performance. The high baseline performance (ceiling effect) of paramedics in this sample may have prevented the potential increase in skills and performance.

A simulated 'can't intubate, can't oxygenate' manikin crossover study investigating a modified front-of-neck access airway device.

A 'can't intubate, can't oxygenate' (CICO) situation is an uncommon and time-critical emergency. Many institutions have adopted a 'scalpel-bougie-endotracheal tube (ETT)' technique based on evidence produced by the 4th National Audit Project of the Royal College of Anaesthetists and 2015 Difficult Airway Society guidelines. We made a modification to the traditional 'scalpel-bougie-ETT' technique, using a shortened bougie and replacing the ETT with a cuffed Melker airway in a preassembled device (called 'Secure Airway for Front-of-neck Emergencies' (SAFE airway device)), which we felt might reduce cognitive load on a single operator in an emergency CICO situation. We then performed a simulation crossover study using 20 volunteer anaesthetic doctors to compare this modification with the traditional technique. After a standardised pre-recorded video demonstration, participants performed simulated tube insertion using both the standard 'scalpel-bougie-ETT' technique and the SAFE airway device in randomised order. Participants were filmed for accurate timestamping. The primary outcome was time to successful tube insertion while secondary outcomes included number of attempts and ease of insertion. Overall time to cuff inflation was shorter, statistically and practically, with the SAFE airway device compared with the ETT (median 30 vs. 52 seconds, P < 0.001). Twenty-five percent of participants required multiple attempts using the ETT method versus 5% using the SAFE airway device, which was also rated as being easier to use. This study demonstrates that the SAFE airway device was fast, effective, easy to use and acceptable to airway practitioners in a simulated manikin environment. These findings indicate that further studies of the SAFE airway device are warranted.

Can I Phone a Friend? Exploring the Use of Digital Devices in Clinical Exams.

Objective structured clinical examinations (OSCEs) are used globally to assess health professional learners' clinical skills and applied knowledge. Despite innovations with simulated participants, manikin technology and real patient involvement, there remains a gap between 'real-life' practice and 'OSCE experience'. For example, although mobile phone use is increasingly common in clinical practice; however, it would represent a significant disruption to established assessment practices in OSCEs. We aimed to explore student use of mobile phones during OSCE assessment, with a focus on exam security, equity and relevance to practice. Cultural Historical Activity Theory (CHAT) allows us to conceptualise and analyse complex systems such as those of OSCE assessment. We recruited a range of stakeholders in a UK medical school setting to participate in focus group interviews exploring our stated aim. Transcripts were analysed using CHAT as a theoretical lens to construct an activity system of assessment and identify emerging tensions around the use of a potentially disruptive technology: students' own mobile phones. Seven examiners, 13 medical students, and two simulated participants participated in three focus groups. Three sources of tension were identified: between the tools of assessment and practice, of exam security and exam relevance, and of medical students as people and professionals. This study exemplifies how a seemingly small disruption in a complex system (introducing a mobile phone-a tool used in everyday practice) can help us understand and describe the unwritten rules of assessment.

Augmented Reality in Ward Round-Based Simulation: Exploring Student Experiences and Impact on Confidence.

Doctors in training make substantial contributions to ward rounds. Despite this, formal education in this area is lacking, leading to diminished confidence and competence among undergraduate students and trainees. Ward round-based simulation (WRBS) has shown promise in improving clinical and decision-making skills.This quasi-experimental mixed-methods study aims to explore student experiences of augmented reality (AR) in simulated medical ward rounds. Specifically, it seeks to compare AR to existing traditional simulation modalities (TSM), manikin, and actor, to evaluate its viability as an alternative and to explore the impact of amixed-modality simulated ward roundon student confidence levels in performing ward round tasks. Fourteen participants engaged in a simulated ward round involving three cases: an actor as a patient, a manikin, and an AR case. Guided by pre- and post-simulation questionnaires, confidence levels around WRBS were explored using Wilcoxon's signed-rank test. Additionally, thematic analysis of semi-structured focus groups explored the use of AR in simulation compared to TSM. Significant improvements in confidence shown through the pre- and post-simulation questionnaires (p < 0.019) were found using Wilcoxon's signed-rank test across all 11 questions, with effect sizes (r) ranging from 0.65 to 0.9. The highest effect size observed (r = 0.9) asked about the change in confidence when starting or stopping medications during a ward round (p = 0.002). Qualitative analysis of focus group discussions identified key themes such as the visual accuracy of AR, the need for interactivity, and the cognitive load of mixed-method simulations. The findings suggest that AR can significantly enhance medical training by providing realistic and immersive learning experiences, although further refinements are necessary to improve interactivity and reduce cognitive demands. This study highlights the potential for integrating innovative technologies to better prepare students for clinical practise and provides further insight into the practicalities of using AR in medical education.

Optimising Healthcare Education with Design-Based Theory

Introduction In complex, and socially dynamic educational systems, traditional research methodologies often fail to connect with everyday practice, creating a need for “usable knowledge” when solving individual and collective education problems (Design-Based Research Collective, 2003). Traditional methods are effective, but do not necessarily uncover the nature of changes to student thinking during an education experience. With this, Design-Based Research (DBR) is a proposed solution that emerges as a pivotal methodology in educational research, as it aims to integrate theories of learning with practical experiences. Seen as a systematic yet adaptable approach, DBR integrates iterative cycles of analysis, design, and evaluation in collaboration with researchers and practitioners within authentic educational settings, (Harrington, 2012; Wang &amp; Hannafin, 2005). This (poster) presentation will describe how DBR was utilised to create a learning environment to improve learning experiences within healthcare education. An analysis of the problem highlighted that healthcare students experienced high levels of anxiety during high-fidelity simulation when asked to perform and treat simulation manikins (Aiello et al., 2023). In part, the main issues relate to a lack of environmental authenticity, resulting in under-stimulation and performance anxiety resulting in over-stimulation. This relates to the Yerkes Dodson stress performance curve and suggests that too little or too much arousal results in poor performance (Yerkes, 1908). The hypothesis therefore was to design a solution for peak performance by increasing environmental authenticity and managing anxiety. Method The hypothesis is conceptualised as a ‘design solution’ rather than an intervention. To provide an authentic learning experience virtual reality environments were developed, and to aid performance anxiety, the centering technique was used. Centering is a visualisation technique that teaches participants to focus on the here and now, reduce negative thoughts, and lower anxiety. Virtual reality scenarios were provided prior to each simulation and included a ward-based environment (nurse students) and a rescue helicopter (paramedic students). The study involved 35 Master of Nursing Science, Entry to Practice student nurses at the University of Melbourne and 33 Bachelor of Health Science, Paramedicine students at Auckland University of Technology and industry experts within nurse and paramedic education. All data was collected for each cohort iteratively in 2023 and 2024 to evaluate and develop the design. Data collection included using the State-Trait Anxiety Inventory as a pre-test baseline to measure general and long-standing anxiety for each participant. Within-test heart rates was recorded on a Polar H10 chest strap to measure an objective physiological response to stress. Post-test participants completed the Competitive State Anxiety Inventory–2R after each simulation to understand subjective anxiety and several focus groups were completed to gain further insight into experiences and perspectives. Discussion and Conclusion This presentation outlines the design characteristics used to support student learning within healthcare education settings. Design-Based Research offers a robust framework to develop and refine educational practices through iterative design and implementation cycles. Early results suggest that both virtual reality and the centering technique impact healthcare learning and the implementation of this approach could lead to long-term resilience and build confidence that maximises potential.

Mesh Refinement for Dynamics Airflow in Health Care

This studyexplores using computational fluid dynamics(CFD) tooptimize ventilation in healthcare, with a focus on mesh refinement for accurate airflow analysis. The goal is to reduce airborne contaminant spread, which is crucial during COVID-19. Ventilation in healthcare ensures air quality and minimizes pathogen transmission. The research analyzer analyzes mesh element size's impact on airflow accuracy in simulated hospital wards with two coughing patients. The optimal mesh size is determined for reliable predictions. Mesh refinement enhances accuracy in critical zones. The k-epsilon turbulence model is chosen for low error. Experimental validation shows temperature discrepancies, likely due to simulated manikins lacking clothing insulation. Air velocity measurements show minor variations within an acceptable range. Further research on various ventilation configurations and airflow rates in real hospital conditions is crucial. Addressing these limitations optimizer optimizeshealthcare ventilation, enhancing safety and infection control.

Analysis of Predicted Thermal Manikin Physiological Responses when Wearing Compression Gear for American College and Pro-Level Football Athletes

From 2012 to 2019, there were approximately 3455 large-scale National Football League injuries reported. There is widespread commercial acceptance of compression garments as tools for reducing injury, promoting recovery, and improving performance in athletic activity. While studies have been conducted to assess the exercise physiology benefits of compression garments, there remains a gap in the scientific literature regarding the clothing comfort and resultant thermoregulation effects of compression girdles for performance athletes. This study aimed to assess the effects of tighter fitting, multi-layer compression systems when worn by American football athletes. A negative impact on thermoregulation may negate or outweigh any realized local benefit such as increased skin blood flow or reduced muscle oscillatory properties. Therefore, the purpose of this research was to determine the predicted hypothalamus temperature, skin blood flow, skin temperature, sweat rate, temperature sensation, and comfort perceptions of the male human body when wearing a compression girdle. A sweating thermal manikin was utilized to predict the physiological responses of a 50th percentile male when wearing football girdles in both practice and play settings. The results indicate significant differences in skin blood flow, skin temperature, core temperature, sweat rate, and comfort and sensation perceptions when wearing compression girdles compared to boxer briefs in replicated practice and play settings. Findings also demonstrate the use of real-time manikin simulation modeling for predicting physiological response outcomes of wearing compression garments to a realized extent.

‘Having skin in the game’: guiding principles for incorporating moulage into OSCEs

BackgroundDermatological conditions are a common reason for patients to seek healthcare advice. However, they are often under-represented in Objective Structured Clinical Examinations (OSCEs). Given the visual nature of skin conditions, simulation is suited to recreate such skin conditions in assessments such as OSCEs. One such technique often used in simulation is moulage—the art and science of using special effects make-up techniques to replicate a wide range of conditions on Simulated Participants or manikins. However, the contextual nature of OSCEs places additional challenges compared to using moulage in more general forms of simulated-based education.Main bodyOSCEs are high-stakes assessments and require standardisation across multiple OSCE circuits. In addition, OSCEs tend to have large numbers of candidates, so moulage needs to be durable in this context. Given the need to expand the use of moulage in OSCE stations and the unique challenges that occur in OSCEs, there is a requirement to have guiding principles to inform their use and development.ConclusionInformed by evidence, and grounded in experience, this article aims to provide practical tips for health profession education faculty on how best to optimise the use of moulage in OSCEs. We will describe the process of designing an OSCE station, with a focus on including moulage. Secondly, we will provide a series of important practice points to use moulage in OSCEs—and encourage readers to integrate them into their day-to-day practice.

The i-view® Video Laryngoscope Compared With the Macintosh Laryngoscope Does Not Enhance the Endotracheal Intubation Skills of Dental Students.

Background A disposable i-view® video laryngoscope (Intersurgical Limited, Berkshire, United Kingdom) is yet to be used to educate medical and dental students, who must learn endotracheal intubation skills. Additionally, the advantage of the i-view® use for the purpose, compared with the Macintosh laryngoscope, is unknown. We aimed to first determine whether the i-view® video laryngoscope enhances endotracheal intubation skills among dental students compared with the Macintosh laryngoscope. Methodology A prospective, observational, simulation study was conducted among 67 dental students in their sixth clinical year of education. Intubation skills were evaluated on a computer-assisted simulator with a standardized manikin. Each student was asked to intubate using the conventional Macintosh laryngoscope and the i-view® video laryngoscope in the trachea of the simulator's manikin. We collected objective data, including the retroflection angle of the manikin, the maxillary incisor contact pressure, time from picking up the laryngoscope to ventilation, intubation success, and intubation delay. Each student was further asked to grade their subjective evaluation concerning the visual field, Cormack and Lehane classification, operability, stability, needed force for intubation, and easiness during intubation. Results Enrolled dental students quoted that the i-view® video laryngoscope demonstrated better visual field, Cormackand Lehane classification, operability, and stability than the Macintosh laryngoscope. However, they felt intubation easiness could have been better using Macintosh than i-view®. Intubation time, failure rate, and delay rate did not differ between the two laryngoscopes. Nevertheless, the maxillary incisor contact pressure (medianinterquartile range (IQR)) during the intubation increased in the i-view® intubation compared with Macintosh (32 (24 to 41) vs. 25 (18 to 35) N, p = 0.010). Conclusions We first demonstrated that the i-view® video laryngoscope compared with the Macintosh laryngoscope does not enhance the endotracheal intubation skills of dental students. However, the possible repeated use as an educational simulator training tool may add some advantages to the experience of video laryngoscope in both medical and dental students.

VR-based Competence Training at Scale: Teaching Clinical Skills in the Context of Virtual Brain Death Examination

Teaching medical practical and soft skills in clinical routines is increasingly difficult, and manikin or actor-based simulations have gained popularity in the last decades. These simulations, however, hardly scale with the demand, are commonly insufficient to train crucial clinical competencies, and cannot portray complex visual and dynamic symptomatologies as required in, for example, brain death examinations. In this paper, we explore the requirements and challenges of integrating a large-scale high-throughput VR setup into a real medical curriculum and describe our approaches and implementation. Therefore we extend and evaluate an interactive virtual reality-based simulation for training brain death diagnostics in a virtual intensive care environment, featuring a fully reactive simulated patient. To enable the required scalability we integrated the simulation into a dedicated hardware and software framework, enabling 12 simultaneous VR trainings which are controlled by a centralized server system. Using this setup we continuously collected feedback on the application's usability and realism from hundreds of students to gain first insights into the applicability of large-scale VR-based learning systems in real course designs. After integrating this feedback, we conducted a controlled curricular study in which we compared the virtual brain death simulation with the classical manikin-based training approach. Our results indicate that the immersive learning experience is perceived to be more realistic and engaging and is overall preferred by the students while also providing the same learning effect as the alternatives.

Using Neurology Trainees as Standardized Patients in a Neurological Emergency Simulation Curriculum for Medical Students.

Simulation manikins have limited ability to mimic neurological exam findings, which has historically constrained their use in neurology education. We developed a cased-based simulation curriculum in which neurology trainees acted as standardized patients (SPs) and portrayed the neurologic exam for medical students. We ran monthly simulations of two cases (acute stroke and seizure) with resident/fellow SPs. Pre-/post-session surveys assessed students' self-rated confidence in neurological clinical skills (gathering a history, performing an exam, presenting a case) and knowledge domains. Questions about students' attitudes about neurology were adapted from a validated assessment tool. Paired t-tests were performed for quantitative items. Qualitative thematic analysis identified key themes. Sixty-one students participated. Post-session, students reported significantly higher self-confidence in all neurological clinical skills and knowledge domains (p < 0.002). Greater than ninety-five percent agreed the session met the learning objectives; 95% recommended it to others. Resident/fellow SPs were cited as the most effective educational component. Students appreciated evaluating acute emergencies and reported an increased interest in neurology careers. A case-based simulation curriculum with neurology trainees portraying the SP increased students' self-reported knowledge, skills, and confidence in managing neurological emergencies. Our intervention may improve medical student neurology education and increase interest in the field. Future research should evaluate clinical skills objectively. The online version contains supplementary material available at 10.1007/s40670-024-02016-w.

Dependence of Successful Airway Management in Neonatal Simulation Manikins on the Type of Supraglottic Airway Device and Providers' Backgrounds.

Supraglottic airway devices such as laryngeal masks and i-gels are useful for airway management. The i-gel is a relatively new device that replaces the air-inflated cuff of the laryngeal mask with a gel-filled cuff. It remains unclear which device is more effective for neonatal resuscitation. We aimed to evaluate the dependence of successful airway management in neonatal simulators on the device type and providers' backgrounds. Ninety-one healthcare providers performed four attempts at airway management using a laryngeal mask and i-gel in two types of neonatal manikins. The dependence of successful insertions within 16.7 s (75th percentile of all successful insertions) on the device type and providers' specialty, years of healthcare service, and completion of the neonatal resuscitation training course was assessed. Successful insertion (p = 0.001) and insertion time (p = 0.003) were associated with using the i-gel vs. laryngeal mask. The providers' backgrounds were not associated with the outcome. Using the i-gel was associated with more successful airway management than laryngeal masks using neonatal manikins. Considering the limited effect of the provider's specialty and experience, using the i-gel as the first-choice device in neonatal resuscitation may be advantageous. Prospective studies are warranted to compare these devices in the clinical setting.

Hyperventilation During Manual Ventilation Can Be Reduced Using a Novel Ventilator but Not With Education Interventions.

Traumatic brain injury (TBI) is the leading cause of combat casualties in modern war with an estimated 20% of casualties experiencing head injury. Since the release of the Brain Trauma Foundation's Guidelines for the Management of Severe Traumatic Brain Injury in 1995, recommendations for management of TBI have included the avoidance of routine hyperventilation. However, both published and anecdotal data suggest that many patients with TBI are inappropriately ventilated during transport, thereby increasing the risk of morbidity and mortality from secondary brain injury. Enlisted Air Force personnel with prior emergency medical technician training completing a 3-week trauma course were evaluated on their ability to provide manual ventilation. Participants provided manual ventilation using either an in-situ endotracheal tube (ETT) or standard face mask on a standardized simulated patient manikin with TBI on the first and last days of the course. Manual ventilation was provided via a standard manual ventilator and a novel manual ventilator designed to limit tidal volume (VT) and respiratory rate (RR). Participants were given didactic and hands-on training on the third day of the course. Half of the participants were given simulator feedback during the hands-on training. All students provided 2 minutes of manual ventilation with each respirator. Data were collected on the breath-to-breath RR, VT, and peak airway pressures generated by the participant for each trial and were averaged for each trial. A minute ventilation (MV) was then derived from the calculated RR and VT. One hundred fifty-six personnel in the trauma course were evaluated in this study. Significant differences were found in the participant's performance with manual ventilation with the novel compared to the traditional ventilator. Before training, MV with the novel ventilator was less than with the traditional ventilator by 2.1 ± 0.4 L/min (P = .0003) and 1.6 ± 0.5 L/min (P = .0489) via ETT and face mask, respectively. This effect persisted after training with a difference between the devices of 1.8 ± 0.4 L/min (P = .0069) via ETT. Both traditional education interventions (didactics with hands-on training) and simulator-based feedback did not make a significant difference in participant's performance in delivering MV. The use of a novel ventilator that limits RR and VT may be useful in preventing hyperventilation in TBI patients. Didactic education and simulator-based feedback training may not have significant impact on improving ventilation practices in prehospital providers.

Usability evaluation of high-fidelity simulation manikin for cardiopulmonary resuscitation training for medical students

Usability evaluation of high-fidelity simulation manikin for cardiopulmonary resuscitation training for medical students

Comparison of Pressure Control Ventilation and Palpation Methods to Protect the Endotracheal Tube Cuff During Tracheotomy: A Manikin Simulation Study.

Objective This study aims to evaluate and compare the suitability and safety of palpation and pressure control ventilation (PCV) methods for the accurate positioning of an endotracheal tube (ETT) cuff. Methods We conducted a pilot simulation randomized crossover study using a medical manikin. Twenty junior resident physicians who had completed anesthesiology training participated in the study. Airway management was performed using a modified manikin designed to simulate palpation and PCV methods. Participants performed both methods in a randomized order. The primary outcome was the number of successful ETT placements. The secondary outcomes were procedure duration and the perceived difficulty of each procedure. Results Five successful procedures were observed in the palpation method group (PALG), while 19 were observed in the PCV method group (PCVG). The duration of the trial was 98 s (standard deviation [SD], 41) in the PALG and 93 s (SD, 49) in the PCVG. The visual analog scale score for difficulty encountered during the trial was 30 (SD, 21) in the PALG and 69 (SD, 19) in the PCVG. Conclusions Our findings suggest that the PCV method had a higher success rate than the palpation method. Thus, the PCV method may be more suitable for inexperienced physicians to perform the procedure with greater confidence.

Favour the best in case of emergency cricothyroidotomy-a randomized cross-over trial on manikin focused training and simulation of common devices.

Performing an emergency cricothyroidotomy (EC) is extremely challenging, the devices used should be easy to handle and the selected technique reliable. However, there is still an ongoing debate concerning the most superior technique. Three different techniques were compared using a standardized, simulated scenario regarding handling, performing, training and decision making: The scalpel-bougie technique (SBT), the surgical anatomical preparation technique (SAPT) and the Seldinger technique (ST). First, anaesthesia residents and trainees, paramedics and medical students (each group n = 50) performed a cricothyroidotomy randomly assigned with each of the three devices on a simulator manikin. The time needed for successful cricothyroidotomy was the primary endpoint. Secondary endpoints included first-attempt success rate, number of attempts and user-satisfaction. The second part of the study investigated the impact of prior hands-on training on both material selection for EC and on time to decision-making in a simulated "cannot intubate cannot ventilate" situation. The simulated scenario revealed that SBT and SAPT were significantly faster than percutaneous EC with ST (p < 0.0001). Success rate was 100% for the first attempt with SBT and SAPT. Significant differences were found with regard to user-satisfaction between individual techniques (p < 0.0001). In terms of user-friendliness, SBT was predominantly assessed as easy (87%). Prior training had a large impact regarding choice of devises (p < 0.05), and time to decision making (p = 0.05; 180 s vs. 233 s). This study supports the use of a surgical technique for EC and also a regular training to create familiarity with the materials and the process itself.The trial was registered before study start on 11.11.2018 at ClinicalTrials.gov (NCT: 2018-13819) with Nicole Didion as the principal investigator.

Age and its impact on crisis management performance and learning after simulation-based education by acute care physicians: a multicentre prospective cohort study

BackgroundPhysiological changes associated with ageing could negatively impact the crisis resource management skills of acute care physicians. This study was designed to determine whether physician age impacts crisis resource management skills, and crisis resource management skills learning and retention using full-body manikin simulation training in acute care physicians. MethodsAcute care physicians at two Canadian universities participated in three 8-min simulated crisis (pulseless electrical activity) scenarios. An initial crisis scenario (pre-test) was followed by debriefing with a trained facilitator and a second crisis scenario (immediate post-test). Participants returned for a third crisis scenario 3–6 months later (retention post-test). ResultsFor the 48 participants included in the final analysis, age negatively correlated with baseline Global Rating Scale (GRS; r=–0.30, P<0.05) and technical checklist scores (r=–0.44, P<0.01). However, only years in practice and prior simulation experience, but not age, were significant in a subsequent stepwise regression analysis. Learning from simulation-based education was shown with a mean difference in scores from pre-test to immediate post-test of 2.28 for GRS score (P<0.001) and 1.69 for technical checklist correct score (P<0.001); learning was retained for 3–6 months. Only prior simulation experience was significantly correlated with a decreased change in learning (r=–0.30, P<0.05). ConclusionsA reduced amount of prior simulation training and increased years in practice, but not age on its own, were significant predictors of low baseline crisis resource management performance. Simulation-based education leads to crisis resource management learning that is well retained for 3–6 months, regardless of age or years in practice.

Integrated Assessment of Discrepancy Between Tracheal Tube and Tube Exchanger as Advancement: A Manikin Simulation Study.

Advancing a tracheal tube over a tracheal tube exchanger into the trachea frequently causes difficulties because of the tube impingement on laryngeal structures. In the present study, we measured the resistance of tube advancement both objectively and subjectively with a variety of combinations of tube exchanger sizes and tracheal tubes using a manikin simulator. Lubricated 7.5 mm ID standard and Parker Flex-Tip (PFT) tracheal tubes were railroaded over the tube exchangers (OD 1-6 mm) into the trachea through the oral route in a manikin. Consequently, 12 combinations of tracheal tube-exchanger tube assemblies were evaluated. Tube advancing resistance at the laryngeal inlet was subjectively evaluated. The objective tube advancing resistance (force) at the laryngeal inlet was evaluated using a digital force gauge. The execution of each tracheal tube-exchanger trial was conducted 10 times. With a 1-mm tube exchanger, all intubation attempts with both standard and PFT tubes failed. Esophageal intubation or severe impingement at the right arytenoid accompanied with a bent tracheal tube was observed. With a 2-mm tube exchanger, during intubation with a standard tracheal tube, rotation of the tube was sometimes required; however, all other intubations were done without problems. When PFT tubes were used, all intubation attempts were performed without problems. The rest of the trials were successfully performed regardless of the combinations of tube exchangers and tracheal tubes; however, one attempt of intubation with a combination of a 5 mm tube exchanger and a standard tracheal tube required withdrawal and rotation of the tube because of impingement at the epiglottis. In cases where there was no gap resistance, which means tube advancing resistance generated by a gap between an introducer and a tracheal tube, the pressing force was approximately less than 10 N. However, in the cases requiring some interventions to overcome the gap, the pressing force reached around 15 N. When intubation failed, for example when the tube bent, or esophageal intubation, the pressing force reached around 30 N. Impingement due to the gap between the tube exchanger and the tracheal tube is thought to occur in the PFT tube less frequently. Once an impingement occurs, we can feel approximately twice the amount of resistance as usual, which may be a chance to consider taking some interventions. When the impingement is not released, regardless of interventions, excessive force may result in esophageal intubation or tracheal injury.

NextGen Training for Medical First Responders: Advancing Mass-Casualty Incident Preparedness through Mixed Reality Technology

Mixed reality (MR) technology has the potential to enhance the disaster preparedness of medical first responders in mass-casualty incidents through new training methods. In this manuscript, we present an MR training solution based on requirements collected from experienced medical first responders and technical experts, regular end-user feedback received through the iterative design process used to develop a prototype and feedback from two initial field trials. We discuss key features essential for an effective MR training system, including flexible scenario design, added realism through patient simulator manikins and objective performance assessment. Current technological challenges such as the responsiveness of avatars and the complexity of smart scenario control are also addressed, along with the future potential for integrating artificial intelligence. Furthermore, an advanced analytics and statistics tool that incorporates complex data integration, machine learning for data analysis and visualization techniques for performance evaluation is presented.