Emergencies, Procedural Training, Thoracotomy, Trauma
Conditions
Brief summary
Resuscitative thoracotomy (RT) is a life saving procedure for patients who have suffered cardiac arrest or are at significant risk of cardiac arrest following significant trauma. The procedure is ideally performed by a surgeon, but in some circumstance must be performed by non-surgical specialists such as Emergency Medicine physicians. The purpose of this study was to evaluate the optimal RT technique taught to non-surgical specialists in an educational human cadaver lab. The objective was to compare time to successful completion of two different RT techniques; (1) Left Anterolateral Thoracotomy (LAT) and (2) Modified Clamshell Thoracotomy (MCT). The investigators hypothesized that the non-surgical specialist time to successful completion for the MCT would be shorter than for the LAT.
Detailed description
The investigators conducted a randomized crossover trial of two resuscitative thoracotomy techniques performed by Emergency Medicine (EM) physicians using a fresh human cadaver model. The purpose was to identify the ideal technique to be taught to non-surgical specialists in a training lab setting. The two techniques compared were the Left Anterolateral Thoracotomy (LAT), commonly taught to EM physicians in the United States, and the Modified Clamshell Thoracotomy (MCT) taught by London's Air Ambulance. The investigators hypothesized that the non-surgical specialists time to successful completion of the RT would be faster when performing the MCT compared to the LAT. The investigators conducted this study at a large level 1 trauma center with an Emergency Medicine residency program and recruited Emergency Medicine residents and staff physicians to participate. Participants were trained on the MCT as performed by LAA and reviewed the LAT technique in a standardized fashion. Participants were then randomized to order of intervention, and conducted each procedure on a separate fresh human cadaver. Participants were evaluated on time to successful completion of the procedure, successful completion of procedural steps, and identification of anatomy. Cadaver specimens were examined for iatrogenic injuries. Participants then completed a standardized survey regarding each procedure.
Interventions
OTHERModified Clamshell Thoracotomy
Participants received standardized training on performing a MCT and LAT. Participants then performed the procedures on a fresh human cadaver model.
OTHERLeft Anterolateral Thoracotomy
Participants received standardized training on performing a MCT and LAT. Participants then performed the procedures on a fresh human cadaver model.
Sponsors
United States Army Institute of Surgical Research
United States Air Force En Route Care Research Center
Centre for Emergency Health Sciences
Barts & The London NHS Trust
The Institute of Pre-Hospital Care at London's Air Ambulance
US Air Force 711th Human Performance Wing
Brooke Army Medical Center
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
OTHER
Masking
NONE
Intervention model description
Participants were randomized to the order of intervention. After completing the first RT technique assigned, participants complete the alternative RT technique
Eligibility
Sex/Gender
ALL
Healthy volunteers
Yes
Inclusion criteria
* licensed physician * emergency medicine residency trainee or graduate * privileged provider at SAMMC
Exclusion criteria
\- unwilling to participate
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Time to successful completion of RT procedure | During procedure on data collection date | Time participant took to complete a successful RT procedure. Success includes (1) successful delivery of the heart and (2) successful cross-clamp of the descending thoracic aorta. Success determined by general surgeon observer. Time start from command go until participant verbalizes delivery of the heart and cross-clamp of the aorta. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Successful descending thoracic aorta cross-clamp defined as 100% occlusion of the descending aorta with a vascular clamp | During procedure on data collection date | Determined by General Surgeon observer |
| Time to delivery of the heart defined as exposure and inspection of all surfaces | During procedure on data collection date | time from command go to subject verbalizing delivery of heart |
| Time to descending thoracic aorta cross clamp defined as 100% occlusion of the descending aorta with a vascular clamp | During procedure on data collection date | total elapsed time from command go to subject verbalizing successful cross-clamping of the descending thoracic aorta |
| Successful delivery of the heart defined as exposure and inspection of all surfaces | During procedure on data collection date | Determined by General Surgeon observer |
| Successful identification of anatomy | During procedure on data collection date | Successful identification of the phrenic nerve, right atrium, left atrium, right ventricle, left ventricle, pulmonary hilum, descending thoracic aorta, and esophagus. |
| Subject Questionnaire | During procedure on data collection date | Procedural ease, comfort, view, equipment comfort and preference. |
| Occurrence of iatrogenic injuries | During procedure on data collection date | Injury to phrenic nerve, esophagus, lung, heart or other anatomical structure as identified by a General Surgeon AI. |
Countries
United States
Outcome results
None listed