Introduction: Vascular injury is a rare but serious complication during neurosurgical procedures. To evaluate the effectiveness of surgical simulation we utilized our established cadaveric endoscopic endonasal cavernous carotid cerebral perfusion and vascular injury model as a means to teach and access paired neurosurgical and anesthesia residents “learner” crisis management.
Methods: Right-side cavernous carotid artery bleeding was perfused. Cadaver head was placed above the SimMan (connected to standard anesthesia operating equipment; real time response and management of cardiac arrythmias, pulmonary and hemodynamic changes were reflected in the SimMan). Learners (neurosurgical; n=6, and anesthesia residents; n=6) were tested on individual crisis management tasks in three patient scenarios (two 7-minute and one 4-minute scenario) per resident pair. Learners performed pre- and post-simulation self-assessment, and resident performance evaluation (individual, communication skills, and functioning as a team), blood loss data, and a pre- and post-anatomical exam data was collected and analyzed.
Results: All neurosurgery residents “would participate in simulated training in the future if given the choice” and strongly agreed that “the model offers benefits not available in existing training modules”. Anesthesia residents agreed (n=1) or strongly agreed (n=5) that the simulation session was “valuable”. A sub analysis comparison of junior (= postgraduate year (PGY) 4; n=3) vs. senior (=PGY 5; n=3) for situation awareness, decision making, communication and teamwork, and leadership revealed that senior residents performed better in all categories, with the largest mean difference in communication and teamwork (t=4.889, p<0.001). For neurosurgery residents blood loss amount significantly improved between scenarios 1129±56.28 compared to 875.8±28.9 (t=3.667, p<0.01). Anatomic knowledge improved pre- vs. post simulation training.
Conclusions: We describe for the first time a novel multi-disciplinary approach to simulation, whereby neurosurgery and anesthesia residents worked together to manage carotid injury. Learner skill set was improved, communication techniques were practiced, and vascular injury algorithms learned.
Patient Care: The simulation allows neurosurgery and anesthesia residents to develop an algorithm for managing vascular injury. These skills directly translate into improved care for patients.
Learning Objectives: 1. the development of a first in kind simulation experience; anesthesia and neurosurgery residents working together
2. learner assessment of a simulated vascular injury model
3. resident performance of appropriate management of carotid injury using a simulated model