Dr Natalie May1, Dr Cliff Reid1, Ms Emma Richardson2, Dr Sebastian Ranguis3
1NSW Ambulance Aeromedical, Sydney, Australia, 2Unreal Anatomy, Evans Head, Australia, 3Ear, Nose & Throat Surgery – Northern Beaches Hospital, Frenchs Forest, Australia
Abstract:
Introduction:
Guidelines recommend open surgical tracheostomy for CICO scenarios in infants, since the cricothyroid membrane is too narrow and cranial to access.
Emergency infant tracheotomy (EIT) is absent from emergency medicine specialist training curricula. This rare but life saving procedure presents a major training challenge.
Objectives:
To design a system for training emergency physicians (EPs) in EIT
Method / Description:
1) Literature review identifying methods and equipment used for EIT by non-ENT surgeons
2) Animal model simulation
3) Conceptual and practical training from a paediatric ENT surgeon during a didactic half day session using a simple model to replicate tissue layers and bleeding
4) Development of sophisticated model using a combination of 3D printing from CT scans, clay sculpting, 3D modeling and silicone moulding with optimised fidelity of age-related anatomic structures, accurate tissue layers, airway collapsibility, major vascular proximity, and embedded synthetic blood to replicate known challenges of the procedure. Model included replaceable neck modules
5) EIT performed on model by paediatric ENT surgeon to feedback on anatomic detail allowing iterative improvement of the neck module
6) Twenty EITs successfully performed by two EPs on improved module to evaluate ergonomic and equipment options until final procedure was agreed
Result / Outcomes:
Key components of successful EP EIT:
1) Minimum two clinicians
2) Operate from side of patient corresponding to primary operator’s dominant arm
3) Strict adherence to midline to avoid vascular structures
4) Adequate light, suction, & retraction to maintain visual appreciation of structures, in contrast tactile technique possible in adults
5) Flat (Ragnell-Davis) retractors preferred to surgical (Backhaus) towel clips
6) Neonatal bougie assists with tracheal tube placement
7) Fine scissors to cut two tracheal rings
8) Repetition significantly reduces procedure time
Conclusion:
EPs can prepare for EIT using a high fidelity model guided by a paediatric ENT specialist.
Biographies:
Biography to come