Simulation training in trauma surgery

As I was scanning the journals today (yes I'm a nerd for doing this on Christmas Day), I came across this interesting study from Arizona, USA, in the Journal of Trauma, December 2011 edition, regarding the use of simulation in training trauma surgeons. The authors describe the use of cadavers to simulate life threatening injuries, connecting the major vessels to perfusate reservoirs and using an intra-aortic balloon pump to create pulsatile flow.

BACKGROUND:

Clinical training in operative technique is important to boost self-confidence in residents in all surgical fields but particularly in trauma surgery. The fully trained trauma surgeon must be able to provide operative intervention for any injury encountered in practice. In this report, we describe a novel training model using a human cadaver in which circulation in the major vessels can be simulated to mimic traumatic injuries seen in clinical practice.

METHODS:

Fourteen human cadavers were used for simulating various life-threatening traumatic injuries. The carotid and femoral arteries and the jugular and femoral vein were cannulated and connected to perfusate reservoirs. The arterial reservoir was connected to an intra-aortic balloon pump, which adds pulsatile flow through the heart and major arteries.Fully trained trauma surgeons evaluated the utility of this model for repairing various injuries in the thoracic and abdominal cavity involving the heart, lungs, liver, and major vessels while maintaining emergent airway control.

RESULTS:

Surgeons reported that this perfused cadaver model allowed simulation of the critical challenges faced during operative trauma while familiarizing the student with the operative techniques and skills necessary to gain access and control of hemorrhage associated with major vascular injuries.

CONCLUSION:

In this report, we describe a novel training model that simulates the life-threatening injuries that confront trauma surgeons. An alternative to living laboratory animals, this inexpensive and readily available model offers good educational value for the acquisition and refinement of surgical skills that are specific to trauma surgery.

This study is also relevant to emergency physicians, who maybe called on to perform time critical procedures such as ED thoracotomy, where current practice is mostly on animals.

Simulation will also likely be increasingly used in the training of non-technical skills (it currently is for surgical trainees), as well as looking at human factors and error reduction in the emergency department setting. Watch this space....

J Trauma. 2011 Dec;71(6):1484-1490.