Authors: (including presenting author): :
NG GWY, SO EHK, CHEUNG VKL, SO CC, MA KCL, CHUNG TCT, LAM MLY, LEUNG ASH, CHIA NH
Affiliation: :
Multi-Disciplinary Simulation and Skills Centre, Queen Elizabeth Hospital
Introduction: :
According to ATLS Manual (10th Ed.), cricothyroidotomy is an emergency surgical airway procedure in which trained medical personnel make an incision in the cricothyroid membrane and insert an endotracheal or a tracheostomy tube into the trachea of patient whose upper airway was obstructed. Since 2013, pig larynxes had been used to train such a rare yet critical procedure in the Advanced Surgical Trauma Course (ASTC). Due to unstable supply and hygiene concerns, Multi-Disciplinary Simulation and Skills Centre (MDSSC) started to explore alternative ways to replace animal models.
Objectives: :
This project aims to reinforce training quality and safety of emergency surgical airway skills workshop by using 3D printing technology in fabricating human-data-generated 3D-printed anatomical models.
Methodology: :
Commenting as an excellent innovative project by Hospital Management Asia 2019, implementation of 3D-printed model requires various elements in mnemonics “M-D-S-S-C”:
“M” --- Multi-disciplinary collaboration (teamwork: 3D Model Service Development and Strategic Planning Committee)
“D” --- Differentiation of ideation (fulfill training and operational needs at international standards)
“S” --- Structural governance and workflow (preparation, processing, application, quality assurance)
“S” --- Sustainability of value creation (potential benefit of implementation with long term goal)
“C” --- Creativity and originality (the first local simulation center making this prototype for training)
On completion of cricothyroidotomy skills workshop, participants were invited to rate on 5-point Likert scales (“4 or above” as “satisfied”) regarding their perception on experience in using 3D-printed trachea. Subcategories include i) enjoyment, ii) realism, iii) practice in safe environment, iv) enhancing learning motivation and v) relevance to clinical practice. Post-training comments from participants, as well as instructors and operating staff, were consolidated for future enhancement.
Result & Outcome: :
Thirty-six medical and nursing staff from clinical departments appraised the effectiveness and innovation of replacing pig larynx with 3D-printed models in emergency surgical airway training in 2019. With comparable overall satisfaction score, implementation of 3D-printed trachea has increased “enjoyment”, “realism” and “safe environment for practice” up to 94.3%. The latter one has significantly enhanced by 11.1%, distinctively. [Conclusion/ Implication] Newly invented 3D-printed trachea could improve realism and training standards, simplify logistics with reusable models and eliminate infection risk of contact with animal tissue. Based on user comments, multiple printing materials, namely polylactide (PLA) and polyvinyl chloride (PVC) with differentiable hardness, have been applied to further enhance realism, particularly tactile sensation on cricothyroid joint. The advanced trainers will be fully utilized in the next training cohort and territory-wide research collaboration.
