High Risk, Low Volume: Evaluation of a Reusable Cricothyrotomy Model in a Paramedic Difficult Airway Training Course

Objectives Cricothyrotomy is considered a procedure of last resort and is exceedingly rare. One large observational study estimated that a cricothyrotomy is performed in less than 1% of prehospital patients requiring advanced airway management. 1 There is minimal literature assessing prehospital cricothyrotomy volume in the US, or assessing provider comfort, experience, or competency in the procedure. A 2016 paper by Furin et al. measured clinical exposure, education and self-perceived competency in performing cricothyrotomy in four ground emergency medical services (EMS) agencies in Pennsylvania.2The authors found that 73% of paramedics felt inadequately trained on the procedure and 40% felt they would likely fail if asked to perform a cricothyrotomy. 2 It's surmised that the majority of active duty paramedics may only perform a cricothyrotomy in a simulation setting during their paramedic refresher course every two years. Previous studies have suggested a marked decay in rarely performed skills, like cricothyrotomy, occurring in anywhere from 2 weeks to several months with time-sensitive procedures performed in stressful scenarios decaying more quickly. 3 , 4 , 5 Thus, having a highly realistic training model to teach this life-saving procedural skill is critical to build and maintain procedural competence. The aim of this study is to evaluate a 3D-printed bleeding cricothyrotomy trainer in increasing paramedic comfort level and procedural competence. Methods Model implementation took place during a mandatory biannual difficult airway training course in November 2019 for all paramedics employed by a hospital-based EMS agency. Participating paramedics performed three surgical cricothyrotomies using the bleeding trainer, and subsequently completed an anonymous written survey. The survey evaluated the comfort level of providers in performing a surgical cricothyrotomy both before and after the training using a ten-point visual analog scale (VAS). Demographic data was also collected and included years of experience as a paramedic, previous experience performing a surgical cricothyrotomy on a patient, and previous training experience in surgical cricothyrotomy. Pre and post comfort levels were compared using paired t tests. Results Forty-four paramedics participated in the difficult airway training course. All (44/44) completed the post-survey. Participants noted that their procedural skill comfort level improved after the training took place (average improvement of 3 ± 1.93. The average comfort level increased from 4.7 before the training to 7.7 after the training (p Conclusion Cricothyrotomy is an infrequently performed yet essential skill for paramedics in the prehospital environment. This bleeding cricothyrotomy trainer provides a high fidelity, cost effective, and more readily available alternative when compared to other surgical airway training models.