1. Randomised Comparison of ORSIM® Bronchoscopy Simulator and Dexter® Endoscopy Trainer in Improving Fibreoptic Endoscopy Skills of Anaesthetic Trainees N.Ungureanu, C.Vaidyanath, C. Mendonca uNiversity hospitals Coventry and Warwickshire, Coventry, united kingdom
ORSIM group
Background: Opportunities to learn and practice fibreoptic intubations depend on the local available expertise and the clinical workload. Deficiencies in training and failure to use the awake fibreoptic intubation technique when indicated, has been highlighted in the UK National Audit Project (NAP4) as a cause for airway morbidity and mortality[1]. Identifying a reliable training method, independent of the above variables, could improve how we teach this essential skill and ultimately patient safety.
Results:
A total of 22 trainees participated in the study (11 in each group) . On an average each trainee performed five oral fibreoptic intubations in both groups. The endoscopy time was analysed by fitting linear mixed models. The mean endoscopy times were shorter in ORSIM™ group than the mean endoscopy time for Dexter® group (56 sec vs 69 sec for the first time intubation and 35 sec vs 47 sec for the subsequent fibreoptic intubations). The difference (12.4 sec) was statistically significant (p=0.040) (See Table 1).
Table 1
The scores for centralisation of fibreoptic scope during endoscopy were higher in ORSIM group and similarly, less number of tissue impacts and better overall handling of the scope was observed in the ORSIM® group (See graphs below).
ORSIM Group DEXTER Group
Methods: The need for ethical approval was reviewed by the local research ethics committee and full ethical approval was not required as the participants were all NHS staff.
Anaesthetic trainees without prior experience in fibreoptic endoscopy, were invited to participate in the study and randomly allocated into two groups. They attended a structured bronchoscopy training session on either the ORSIM® (Airway Ltd, Auckland, New Zealand) high-fidelity 3D dynamic bronchoscopy simulator (Fig 1) or the Dexter® (Replicant Ltd, Welllington, New Zealand) endoscopy trainer (Fig 2).
Fig 1
Fig 2
Within 4 weeks of receiving the training, participants were given the opportunity to perform a series of asleep oral fibreoptic intubations in patients requiring oral tracheal intubation. Their performance was assessed by one of the investigator (CM). During the intubation attempt, the time taken to complete the endoscopy (from insertion of the scope into the oral cavity until carina is visualised) was recorded as the primary outcome. Secondary outcomes were: centralisation of the fibreoptic scope in the airway, the number of tissue impacts and overall performance, which were all scored between 1 and 5 (5 being scope in the centre of airway throughout or no tissue impacts and 1 being scope not being in the centre for most of the path or more than five tissue impacts).
Endoscopy serial no.
Endoscopy serial no.
Conclusions:
ORSIM® bronchoscopy simulator offered an advantage in terms of time taken to complete the endoscopy on patients over Dexter® endoscopy trainer.
The superiority of ORSIM® simulator in decreasing the time taken by a participant to perform fibreoptic intubations on a virtual patient was demonstrated before [2] .Our study tried to ascertain the transition from the virtual to the clinical environment and the impact different airway simulators could have on teaching novices, in an attempt to avoid “practicing for the first time” on patients and its inherent problems.
References:
1. Cook TM, Woodall N, Frerk C; Fourth National Audit Project. Major complications of airway management in the UK. Br J Anaesth 2011;
2. Benumof JL. Magement of the difficult adult airway. Anesthesiology 1991; 75:1087– Rowe R. An Evaluation of Virtual Reality Airway Simulator;.Anesth Analg 2002; 95: 62– 66

2. SUMMARY
Our study tried to ascertain the transition from the virtual to the clinical environment and the impact different airway simulators could have on teaching novices
ORSIM® bronchoscopy simulator offered an advantage over Dexter® endoscopy trainer in terms of time taken to complete the endoscopy on patients after training
Better overall handling, centralisation of the scope and less number of tissue impacts were also observed in the ORSIM® group