Procedures that are high acuity, high stakes, time sensitive and low in frequency like the surgical airway require repeated training in both the technical and nontechnical aspects.

The actual procedure itself is relatively simple but the decision to proceed without hesitation is the most important element.  Recognizing that unanticipated difficult airways occur, always having a plan for failure and identifying the surgically inevitable airway early will help the team perform a surgical airway when it is required before too late.

Various cric trainers of different fidelity are available. Manufactured cric trainers (e.g. Laerdal, SynAtomy, Life/form) are generally very expensive but a simple model can be made from various commonly found items.

Scott Weingart‘s cric model consisted of rolls of tape and ventilator tubing and works very well to simulate the motor skills required for the procedure.

Chris Bond has a variation of this cric trainer with a video on its construction.

Rob Bryant has an edible version of the cric trainer described on the PHARM and in video.

At SMACC Chicago 2015, Rich Levitan had developed custom 3D printed cric models for everyone to train at the airway workshop.

Pig and lamb trachea from a local butcher shop also serves as a very good model but there may be institutional restrictions on use of animal tissue in certain settings.

These animal trachea can be frozen and thawed just before use.

Rob Bryant has also mentioned the use of “science grade” pig tracheas preserved  in 1% formaldehyde and packaged (refrigerate after opening) with foam tape over for skin.

Sydney HEMS takes it one step further with their own custom mannequin complete with skin and head. They train in a team and practice their communications at the same time.

Verbalizing the procedure by the operator can be a practiced reflexive habit to help focus oneself on the procedural steps in crisis as well as communicate the situation to the team in order for them to anticipate assistance.

The Sydney HEMS induction training also has a pig lab for practicing cricothyrotomy.

No matter what type of model one uses, it is important to think and practice such a low frequency and high acuity skill at least every so often in order that one is ready when that situation comes. Practicing high fidelity does not necessarily require expensive mannequins or pig labs. Training in teams and in the non-technical skills is just as crucial as the procedure itself.

Original post 2015-08-24, Yen Chow