Cricothyroidotomy Simulator: A Makerspace and Augmented Reality Approach

A cricothyroidotomy is an incision made on the cricothyroid membrane at its midline to create an airway for oxygenation and ventilation. Cricothyroidotomy is a complex procedure involving motor, psychological, and decision-making skills, amply used during the COVID-19 pandemic. This procedure requires extensive training, and simulators facilitate teaching advanced airway management techniques to health care professionals. However, upper airway simulators are expensive and limited to specialized facilities inaccessible during the COVID-19 pandemic when in-laboratory practices shifted to online synchronous and asynchronous teaching. Such a scenario sparked interest in makerspace technologies for creating cost-effective simulators. This paper presents the prototyping of a cricothyroidotomy simulator through a Design Thinking approach to ideate a cost-effective solution that contains all 3D printed structures properly representing the real anatomical parts needed for the procedure. Additionally, we propose an augmentation of the 3D printed model employing Augmented Reality (AR) to enhance how information about the procedure can be accessed without relying on traditional instruction materials. Our preliminary results have led to a makerspace cricothyrotomy simulator used in training sessions in conferences and workshops and the prototyping of an AR complementary tool. © 2022 IEEE.

Simulation of Adult Surgical Cricothyrotomy for Anesthesiology and Emergency Medicine Residents: Adapted for COVID-19.

Introduction: In a CICO (cannot intubate, cannot oxygenate) situation, anesthesiologists and acute care physicians must be able to perform an emergency surgical cricothyrotomy (front-of-neck airway procedure). CICOs are high-acuity situations with rare opportunities for safe practice. In COVID-19 airway management guidelines, bougie-assisted surgical cricothyrotomy is the recommended emergency strategy for CICO situations. Methods: We designed a 4-hour procedural simulation workshop on surgical cricothyrotomy to train 16 medical residents. We provided prerequisite readings, a lecture, and a videotaped demonstration. Two clinical scenarios introduced deliberate practice on partial-task neck simulators and fresh human cadavers. We segmented an evidence-based procedure and asked participants to verbalize the five steps of the procedure on multiple occasions. Results: Thirty-two residents who participated in the workshops were surveyed, with a 97% response rate (16 of 16 from anesthesiology, 15 of 16 from emergency medicine). Participants commented positively on the workshop's authenticity, its structure, the quality of the feedback provided, and its perceived impact on improving skills in surgical cricothyrotomy. We analyzed narrative comments related to three domains: preparation for the procedure, performing the procedure, and maintaining the skills. Participants highlighted the importance of performing the procedure many times and mentioned the representativeness of fresh cadavers. Discussion: We developed a surgical cricothyrotomy simulation workshop for anesthesiology and emergency medicine residents. Residents in the two specialities uniformly appreciated its format and content. We identified common pitfalls when executing the procedure and provided practical tips and material to facilitate implementation, in particular to face the COVID-19 pandemic.