By guest author Evan Fallon, Simulationist at OhioHealth Learning
Three percent of all trauma-related deaths occur from penetrating thoracic trauma. Emergency Department thoracotomy (EDT) is a rare, but lifesaving procedure for victims of penetrating chest trauma. Special training and deliberate practice is needed to perform this low frequency procedure. There is a limited availability of low-cost simulation solution to teach this life-saving procedure to residents. Cost of traditional Halstedian training of a surgery resident is approximately USD 80000/resident/year. Cost of complex hi-fidelity simulators (USD 5000 to USD 200000 or more) adds to the total cost of the training. This procedure warrants deliberate practice before performing it on a live patient during an emergency. Although a human cadaver can offer better anatomic landmarks and fidelity, access to them is limited due to high cost and scarcity of donated bodies. Outcomes for different modalities used for simulation-based training of emergency procedures on animal tissue, cadavers or bench-top models are comparable.
Since there is no gold standard training method for EDT, we hope to show that a low cost training model may fill this gap. Our aim was to develop an EDT trainer in less than 300 USD. To develop our trainer we focused on providing a solution to practice the important steps of antero-lateral emergency thoracotomy such as: to use the instruments and the rib retractor correctly as well to perform pericardiotomy and cross clamping of the descending aorta.
We customized a commercially available cardio pulmonary resuscitation manikin, created low cost organ models (heart, lung, aorta, esophagus, fat & skin) to fit in the manikin. To create the lung model we used soft packing foam block and hand crafted it. We coated it with medium grade premium degassed liquid plastisol to provide realistic feel and tissue characteristic. Similarly, the model of human heart and aorta was made by coating a cone shaped structure with liquid plastic. Left side ribs were bought from market and were used to create the 5th & 6th intercostal space. We fixed the ribs with zip ties. We made 10 pairs of skin and fat. To make the piece of skin of size 8inch x 18inch we used the following formula:
Liquid plastic 600ml + white color 3 ml + pumpkin color 5ml. After mixing it thoroughly for 1 minute we heated the solution in a microwave for 4 minutes. Stir it for 20 seconds and reheated it. Poured the mix in a baking tray to make a skin of 2mm of thickness and let it set for 15 minutes.
To make a layer of Fat we used the same method as for making the skin but replaced the pumpkin color by 5 ml of gold color.
To create cardiac tamponade we filled a shower cap with artificial blood and tied it to the heart model using a zip tie.
This simulator was developed by the help of Asit Misra MD, Edward Dominguez MD, FACS and William Watson MD, FACS.
The table below shows the break up cost of our trainer: