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J Surg Res. 2015 Jul;197(1):78-84. doi: 10.1016/j.jss.2015.04.037. Epub 2015 Apr 17.

Simulation trainer for practicing emergent open thoracotomy procedures.

Author information

1
Arizona Simulation Technology and Education Center, College of Medicine, University of Arizona Health Sciences Center, University of Arizona, Tucson, Arizona. Electronic address: allan@surgery.arizona.edu.
2
Arizona Simulation Technology and Education Center, College of Medicine, University of Arizona Health Sciences Center, University of Arizona, Tucson, Arizona.
3
Division of Cardiothoracic Surgery, Department of Surgery, University of Arizona Medical Center, University of Arizona, Tucson, Arizona.

Abstract

BACKGROUND:

An emergent open thoracotomy (OT) is a high-risk, low-frequency procedure uniquely suited for simulation training. We developed a cost-effective Cardiothoracic (CT) Surgery trainer and assessed its potential for improving technical and interprofessional skills during an emergent simulated OT.

MATERIALS AND METHODS:

We modified a commercially available mannequin torso with artificial tissue models to create a custom CT Surgery trainer. The trainer's feasibility for simulating emergent OT was tested using a multidisciplinary CT team in three consecutive in situ simulations. Five discretely observable milestones were identified as requisite steps in carrying out an emergent OT; namely (1) diagnosis and declaration of a code situation, (2) arrival of the code cart, (3) arrival of the thoracotomy tray, (4) initiation of the thoracotomy incision, and (5) defibrillation of a simulated heart. The time required for a team to achieve each discrete step was measured by an independent observer over the course of each OT simulation trial and compared.

RESULTS:

Over the course of the three OT simulation trials conducted in the coronary care unit, there was an average reduction of 29.5% (P < 0.05) in the times required to achieve the five critical milestones. The time required to complete the whole OT procedure improved by 7 min and 31 s from the initial to the final trial-an overall improvement of 40%.

CONCLUSIONS:

In our preliminary evaluation, the CT Surgery trainer appears to be useful for improving team performance during a simulated emergent bedside OT in the coronary care unit.

KEYWORDS:

Cardiothoracic; Medical; Simulation; Surgical education; Thoracotomy

PMID:
25959836
DOI:
10.1016/j.jss.2015.04.037
[Indexed for MEDLINE]

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