Airway management is a fundamental skill in operating theatres, emergency and intensive care units. One of the most serious problems that we can find is the “Can’t Intubate-Can’t Oxygenate” situation. Although this is a rare condition, this is still a cause of high morbidity and mortality.1
Emergency cricothyrotomy, an invasive technique that allows immediate access to the airway, could be the only vital solution in this extremely serious situation.2,3 Therefore, training both technical and non-technical skills is decisive, and simulation may play a fundamental role.
Following SAFETY project philosophy of sharing experiences and knowledge in clinical simulation, here in Hospital Clínic de Barcelona (Spain) we would like to share an innovative and low-cost surgical cricothyrotomy phantom custom-designed by our team, which is based on the REAL CRIC Trainer model.4 This version can also be used in simulation scenarios, thus adding the clinical context to the performance of the technique. As an advantage, this model is made of cheap readily available materials, and is therefore accessible to anyone at a lower price when compared to commercial models. In addition, the device offers a good ultrasound fidelity.
The article where the model is described is open access in the journal Educación Médica (article in press, https://doi.org/10.1016/j.edumed.2020.12.003).5
Written by Lidia Gómez – SIMCLÍNIC Simulation Group, Hospital Clínic of Barcelona, Spain
1 – S. Langvad, P.K. Hyldmo, A.R. Nakstad, G.E. Vist, M. Sandberg. Emergency cricothyrotomy-a systematic review. Scand J Trauma Resusc Emerg Med, 21 (2013), p. 43
2 – DAS guidelines for management of unanticipated difficult intubation in adults 2015. Difficult Airway Society [Internet]. Available from: https://das.uk.com/guidelines/das_intubation_guidelines
3 – F. Heymans, G. Feigl, S. Graber, D.S. Courvoisier, K.M. Weber, P. Dulguerov. Emergency cricothyrotomy performed by surgical airway–naive medical personnel. A randomized crossover study in cadavers comparing three commonly used techniques. Anesthes [Internet], 125 (2016), pp. 295-303. Available from: https://anesthesiology.pubs.asahq.org/article.aspx?articleid=2528137
4 – J. Kei, D.P. Mebust, L.V. Duggan. The REAL CRIC trainer: instructions for building an inexpensive, realistic cricothyrotomy simulator with skin and tissue, bleeding, and flash of air. J Emerg Med [Internet], 56 (2019), pp. 426-430. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0736467918312150
5 – A. Calvo, C.I. Esteve, V. Varela et al. Design, application and evaluation of a cricothyrotomy model for a multidisciplinary simulation. An observational single centre study. Educación Médica. Article in press. Available from: https://doi.org/10.1016/j.edumed.2020.12.003