Increasing access to simulation opportunities for emergent cricothyrotomy using a 3D model and positive pressure

Inexpensive, accessible models for simulation are essential to prepare providers to perform cricothyrotomy (CT), a rarely performed but critical procedure. We assessed a portable and inexpensive open-sourced 3D printed CT model versus a routine simulation model for training. Residents and fellows of an academic Emergency Medicine (EM) program were randomized to complete a training session for CT with a conventional mannequin or the novel CT technique. After a two-week washout period, all participants performed a CT on an animal surrogate while EM attendings, blinded to assignment of participant training session, evaluated participants with a standardized checklist of steps of the technique. The data collected assessed the primary endpoint of successful completion of the checklist, as well as time to ventilation. Successful checklist completion was similar between groups, conventional group median success rate (MSR)100% of checklist items, interquartile range (IQR) of 86-100%. The novel training group MSR was 100% (IQR 93-100%), p = 0.42, consistent with noninferiority of the novel technique. For time to ventilation, Group 1 had a median time (MT) of 133 s (IQR 84-165) with Group 2 having a MT of 63 sec (IQR 53-130). Our CT training technique demonstrated non-inferiority to a conventional training mannequin with respect to success rate for learners. Furthermore, the time to ventilation was faster in the group trained with the novel model. Coupled with intrinsic economic and logistical advantages over conventional techniques, this model provides an effective means of reinforcing skill in a rare procedure.