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CRICOTHYROIDOTOMY TRAINER REVIEW

The DAS 2015 guidelines for the management of unanticipated difficult intubation in adults advocate scalpel cricothyroidotomy for emergency front-of-neck access in the anaesthetised and paralysed patient where intubation and oxygenation has failed (Plan D).

Every anaesthetist should be trained to perform the Plan D technique. This document provides a summary of the features and fidelity of simulator trainers currently available to help provide this training.

trainers currently available to help provide this training. We advocate Plan D part task training in

We advocate Plan D part task training in two phases: Initial technical and motor skill development with low fidelity simulators, followed by simulation to

advance non-technical and psychological skills in a stressful situation. conjuction with the trainers below.

This can be achieved using commercially available simulation apps (e.g., SimMon) in

commercially available simulation apps (e.g., SimMon) in HIGH-FID ELITY EXTREME AIRWAY TRAINER Cost Set-up Fidelity

HIGH-FIDELITY EXTREME AIRWAY TRAINER

Cost

Set-up

Fidelity

CTM Palpable

Incision

Ultrasound

Latex

Vertical

£

Fidelity CTM Palpable Incision Ultrasound Latex Vertical £ + X Incorporates home-made element manufacture and

+

X

Incorporates home-made element manufacture and assembly.

Excellent haptic feedback from the

ADAMgel, allows cut-down tech-

nique. Only ultrasound-compatible

model in this list.

tech- nique. Only ultrasound-compatible model in this list. VARADA Y ET AL HOMEMADE CRICOTHYROTOMY MODEL Cost

VARADAY ET AL HOMEMADE CRICOTHYROTOMY MODEL

Cost

Set-up

Fidelity

CTM Palpable

Incision

Ultrasound

Latex

Vertical

£

Fidelity CTM Palpable Incision Ultrasound Latex Vertical £ Requires assembly, from readily available equipment. -

Requires assembly, from readily available equipment.

- Would make ideal model for

acquiring initial motor skills forreadily available equipment. - Would make ideal model for X X X Plan D technique before

X

X

X

Plan D technique before moving

onto higher fidelity models.

Plan D technique before moving onto higher fidelity models. SIMULA IDS CRICOTHYROTOMY TRAINER DELUXE No. 13

SIMULAIDS CRICOTHYROTOMY TRAINER DELUXE No. 135

Cost

Set-up

Fidelity

£ £

TRAINER DELUXE No. 13 5 Cost Set-up Fidelity £ £ Internal tube simulates CTM but when

Internal tube simulates CTM but when present has tendency to

- redirect bougie into false passage.

CTM Palpable p Vertical Incision X Ultrasound X Latex p
CTM Palpable
p
Vertical
Incision
X
Ultrasound
X
Latex
p

Very prominent cricothyroid gap.

Lubrication required.

p Very prominent cricothyroid gap. Lubrication required. VBM CR ICO-TRAINER ADELAIDE Cost Set-up Fidelity CTM

VBM CRICO-TRAINER ADELAIDE

Cost

Set-up

Fidelity

CTM Palpable

Incision

Ultrasound

Latex

Vertical

£ £

CTM Palpable Incision Ultrasound Latex Vertical £ £ Very prominent thyroid cartilage with prominent

Very prominent thyroid cartilage with prominent cricothyroid gap.

- Low-cost foam skin inserts.

p
p

X

X

p
p
cricothyroid gap. - Low-cost foam skin inserts. p X X p V B M C R

VBM CRICO-TRAINER FROVA

 

Cost

£

£

Set-up

Set-up

Fidelity

-

CTM Palpable

X

Vertical

Incision

X

Ultrasound

X

 

Latex

p
p

Improved laryngeal cartilage design, low-cost foam skin inserts

with very easy set-up.

design, low-cost foam skin inserts with very easy set-up. LAERDAL CRICOID STICK SIMULATOR   Cost £

LAERDAL CRICOID STICK SIMULATOR

 

Cost

£

£ £

Set-up

Set-up

Fidelity

-

CTM Palpable

X

Vertical

Incision

X

Ultrasound

X

 

Latex

p
p

Unable to perform Plan D tech- nique on this model with its current

design.

© Dr Bhavesh Patel, Dr Toby Winterbottom & Dr Wendy KIng 2017

P H A R M A B O T I C S C R I

PHARMABOTICS CRICOTRACHEOTOMY TRAINER

Cost

Set-up

Fidelity

CTM Palpable

Incision

Ultrasound

Latex

Vertical

£ £ £

CTM Palpable Incision Ultrasound Latex Vertical £ £ £ T B C Convincing differentiation of ‘cartilaginous’

TBC

Convincing differentiation of

‘cartilaginous’ structures andVertical £ £ £ T B C Convincing differentiation of + CTM. Lubrication required (not supplied).

+ CTM. Lubrication required (not

supplied).structures and + CTM. Lubrication required (not X X eNASCO LIFE/FORM CRICOTHYROTOMY SIMULATOR Cost Set-up

X

X

and + CTM. Lubrication required (not supplied). X X eNASCO LIFE/FORM CRICOTHYROTOMY SIMULATOR Cost Set-up

eNASCO LIFE/FORM CRICOTHYROTOMY SIMULATOR

Cost

Set-up

Fidelity

CTM Palpable

Incision

Ultrasound

Latex

Vertical

£ £ £ £

Only the ‘Open’ style laryngeal

insert permits Plan D technique.Vertical £ £ £ £ Only the ‘Open’ style laryngeal + Internal clear tube simulates CTM,

+ Internal clear tube simulates

CTM, but when present haspermits Plan D technique. + Internal clear tube simulates X X X tendency to redirect bougie

X

X

X

tendency to redirect bougie

into false passage. Lubrication

required (supplied).

bougie into false passage. Lubrication required (supplied). SMITHS MEDICAL TRACHEOSTOMY HEAD Cost Set-up Fidelity CTM

SMITHS MEDICAL TRACHEOSTOMY HEAD

Cost

Set-up

Fidelity

CTM Palpable

Incision

Ultrasound

Latex

Vertical

£ £ £ £

CTM Palpable Incision Ultrasound Latex Vertical £ £ £ £ + X X X p Rigid

+

X

X

X

p
p

Rigid thyroid cartilage. Lubrica- tion required (not supplied).

thyroid cartilage. Lubrica - tion required (not supplied). TRUCOR P AIRSIM TRUCRIC Cost Set-up Fidelity CTM

TRUCORP AIRSIM TRUCRIC

Cost

Set-up

Fidelity

CTM Palpable

Incision

Ultrasound

Latex

Vertical

£ £ £ £

CTM Palpable Incision Ultrasound Latex Vertical £ £ £ £ Lower fidelity than alternative TruCorp product.

Lower fidelity than alternative TruCorp product. Laryngeal

+ inserts provide realistic CTM

p
p

X

X

p
p

haptic feedback.

+ inserts provide realistic CTM p X X p haptic feedback. VBM CRI CO-TRAINER PIG Cost

VBM CRICO-TRAINER PIG

Cost

Set-up

Fidelity

£ £ £ £

VBM CRI CO-TRAINER PIG Cost Set-up Fidelity £ £ £ £ Requires separate supply of porcine

Requires separate supply of porcine larynx, with ensuing

+ refrigerated storage and

hygiene issues.

CTM Palpable p Vertical Incision X Ultrasound X Latex p
CTM Palpable
p
Vertical
Incision
X
Ultrasound
X
Latex
p
Palpable p Vertical Incision X Ultrasound X Latex p SYNDAVE R ADULT CRIC TRAINER   Cost

SYNDAVER ADULT CRIC TRAINER

 

Cost

£

Set-up

£ £ £ £ TBC

£ £ £ £ TBC

Fidelity

+

CTM Palpable

p
p

Vertical

Incision

p
p

Ultrasound

X

 

Latex

X

Not tested directly; requires shipping direct from supplier in

United States. ‘Low-cost Adult

Cric Trainer’ no longer available

from this manufacturer.

Cric Trainer’ no longer available from this manufacturer. LAERDAL DELUXE DIFFICULT AIRWAY TRAINER Cost Set-up

LAERDAL DELUXE DIFFICULT AIRWAY TRAINER

Cost

Set-up

Fidelity

£ £ £ £ £ TBC
£
£ £ £ £
TBC

Optional CTM tape available to simulate fibrous membrane

+ for puncture. Allows combined

airway management and Plan D

simulation

CTM Palpable p Vertical Incision X Ultrasound X Latex p
CTM Palpable
p
Vertical
Incision
X
Ultrasound
X
Latex
p
Palpable p Vertical Incision X Ultrasound X Latex p TRUCOR P AIRSIM ADVANCE COMBO Cost Set-up

TRUCORP AIRSIM ADVANCE COMBO

Cost

Set-up

Fidelity

£ £ £ £ £

P AIRSIM ADVANCE COMBO Cost Set-up Fidelity £ £ £ £ £ CTM Palpable p Vertical
CTM Palpable p Vertical Incision X Ultrasound X Latex p
CTM Palpable
p
Vertical
Incision
X
Ultrasound
X
Latex
p

Floating larynx provides addi- tional realism. Allows combined

tion required (supplied).

+ advanced airway management

and Plan D simulation. Lubrica-

KEY

Cost :

£ £0 - £249 £ £ £250 - £499 £ £ £ £500 - £749 £ £ £ £ £750 - £999

£ £0 - £249 £ £ £250 - £499 £ £ £ £500 - £749 £

-

£ £0 - £249 £ £ £250 - £499 £ £ £ £500 - £749 £
£ £0 - £249 £ £ £250 - £499 £ £ £ £500 - £749 £

£

£ £ £ £ > £1000

Set-up :

Fidelity:

INVOLVED STRAIGHTFORWARD VERY EASY LOW: skin, thyroid cartilage, cricoid cartilage, hollow trachea

 

+ HIGH: as above incorporating: skin texture, subcutaneous layers, fibrous CTM, tracheal rings, mandible, face, tracheal path

CTM Palpable / Vertical Incision / Ultrasound / Latex:

pYES X NO

/ Vertical Incision / Ultrasound / Latex: p YES X N O © Dr Bhavesh Patel,

© Dr Bhavesh Patel, Dr Toby Winterbottom & Dr Wendy KIng 2017