Simulation trainer for practicing emergent open thoracotomy procedures

J Surg Res. 2015 Jul;197(1):78-84. doi: 10.1016/j.jss.2015.04.037. Epub 2015 Apr 17.


Background: An emergent open thoracotomy (OT) is a high-risk, low-frequency procedure uniquely suited for simulation training. We developed a cost-effective Cardiothoracic (CT) Surgery trainer and assessed its potential for improving technical and interprofessional skills during an emergent simulated OT.

Materials and methods: We modified a commercially available mannequin torso with artificial tissue models to create a custom CT Surgery trainer. The trainer's feasibility for simulating emergent OT was tested using a multidisciplinary CT team in three consecutive in situ simulations. Five discretely observable milestones were identified as requisite steps in carrying out an emergent OT; namely (1) diagnosis and declaration of a code situation, (2) arrival of the code cart, (3) arrival of the thoracotomy tray, (4) initiation of the thoracotomy incision, and (5) defibrillation of a simulated heart. The time required for a team to achieve each discrete step was measured by an independent observer over the course of each OT simulation trial and compared.

Results: Over the course of the three OT simulation trials conducted in the coronary care unit, there was an average reduction of 29.5% (P < 0.05) in the times required to achieve the five critical milestones. The time required to complete the whole OT procedure improved by 7 min and 31 s from the initial to the final trial-an overall improvement of 40%.

Conclusions: In our preliminary evaluation, the CT Surgery trainer appears to be useful for improving team performance during a simulated emergent bedside OT in the coronary care unit.

Keywords: Cardiothoracic; Medical; Simulation; Surgical education; Thoracotomy.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Clinical Competence
  • Education, Medical, Continuing / methods*
  • Emergencies
  • Feasibility Studies
  • Humans
  • Interprofessional Relations
  • Manikins*
  • Models, Educational*
  • Patient Care Team
  • Thoracic Surgery / education*
  • Thoracotomy / education*
  • Thoracotomy / methods
  • Time Factors
  • United States