A Multidisciplinary International Collaborative Implementing Low Cost, High Fidelity 3D Printed Airway Models To Enhance Ethiopian Anesthesia Resident Emergency Cricothyroidotomy Skills

Publication date: Available online 1 September 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Virginia T. Gauger, Deborah Rooney, Kevin J. Kovatch, Lauren Richey, Allison Powell, Hailesllassie Berhe, David A. Zopf

Abstract

Background

Similar to other sub-Saharan countries, Ethiopia suffers from a severe shortage of adequately trained health professionals. Academic partnerships can support sustainable training programs and build capacity for low-resource settings. 3D modeling and simulation-based training provide necessary tools, especially for rarely-encountered clinical situations, such as needle cricothyroidotomy.

Methods

Departments of Anesthesiology, Otolaryngology, and Learning Health Sciences collaborated to develop a low-cost, high-fidelity simulator and Cricothryoidotomy Skills Maintenance Program (CSMP). Twelve anesthesia residents at St. Paul's Hospital Medical Millennium College in Addis Ababa, Ethiopia participated in CSMP. The program consisted of a didactic session with presentation and demonstration and an immersive CICO scenario. Program evaluation was performed using pre/post-training knowledge and 2 procedural performance assessments-the CSMP Global Rating Scale and the Checklist. With consent, performances were videotaped and rated independently by 3 University of Michigan faculty.

Results

Improvements were identified in all areas, including residents' knowledge, measured by mean summed test scores, (Mpre=3.31,Mpost=4.46, p=0.003), time to perform cricothyroidotomy (Mpre=96.64,Mpost=72.82,p=0.12), residents' performance quality, measured by overall mean Global ratings, (Mpre=0.20;Mpost=0.70) with improvements identified at the item-level, p=0.001 with moderate-large effect sizes, and residents' ability to complete tasks, measured by mean Checklist ratings (Mpre=0.51,Mpost=0.90, with item-level improvements observed, p≤0.01, with small-large effect sizes. Residents' self-reported confidence also improved, (Mpre=1.69, Mpost=3.08,p=0.001.

Conclusion

Our work shows that cricothyroidotomy skills taught to anesthesia residents at SPHMMC with a 3D printed laryngotracheal model improves knowledge, skills, and confidence. The creation of a low-cost, high-fidelity simulator and a CSMP has the potential to impact patient care and safety world-wide.

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