Traditional Poster Round
Context: : Emergency resternotomy (ERS) is a high-risk, low-frequency procedure which can directly impact on survival, and for which skills training is essential and mandated1, 2. Simulation fidelity affects participants’ engagement and is crucial for learning and training. We therefore aimed to develop a chest opening skills trainer in order to improve learning through improved overall fidelity and technical aspects of ERS training.
Description: : An innovative ERS skills trainer prototype COSTA (Chest Opening Skills Trainer) was developed by the Simulated interPRofessional Team Training (SPRinT) programme team members in partnership with a medical model manufacturer. The skills trainer has reinforced silicone skin with a pre-made incision allowing high fidelity, layered suturing and repeated use. The sternum has pre-made holes for wire closure and a patented sternal resistance mechanism providing an authentic tactile experience on reopening. In situ endotracheal tube and central line allow ventilation and infusion of fluids and medications, and its silicone heart has accurate external anatomy. COSTA was tested against the ERS mannequin normally used at a one-day national Cardiac Advanced Life Support (CALS) course provided by Royal Brompton and Harefield NHS Foundation Trust. All participants either performed or observed an ERS on both models and then completed a questionnaire on quality and realism of the new skills trainer.
Observation/Evaluation: : 11 participants (4 nurses and 7 doctors) including 1 cardiothoracic surgery fellow and 1 anaesthetic consultant participated on the course. In terms of previous real ERS experience, 4 had never performed it, 5 performed it 1-3 times, and 2 performed it more than 5 times. Compared to the CALS mannequin, the COSTA offered better realism, ease of use, skin incision opening and sternal retractor placement (table 1). Sternal aperture width was considered better by 50% of participants (table 1). Median level of agreement of participants in relation to face validity (statements 1 to 3) and content validity of the COSTA (statements 4 & 5), and improved technical skills and confidence to manage future events was above 70% (table 2). Feedback from surgeon was that “…lasted well despite being re-sutured and reused. Better than the last one! … I was surprised. Sutures are normally embedded deep in tissue, (it) felt like cutting through layers”.
Discussion: : The COSTA prototype was highly rated by CALS course participants. It provided better face and content validity, technical aspects for the procedure and ease of use compared to the current CALS mannequin. We believe that this model is the first in the world to provide a realistic effective tool for cardiothoracic team training and incorporating this model into future ERS courses could help improve learning in this life-saving procedure. Future studies are needed to investigate construct validity.