Randomised Comparison of ORSIM™ Bronchoscopy Simulator and Dexter® Endoscopy Trainer in Improving Fibreoptic Endoscopy Skills of Anaesthetic Trainees

Abstract

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 traine. 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.

Full text

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
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.
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).
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.
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
References:
1. Cook TM, Woodall N, Frerk C; Fourth National Audit Project. Major complications of airway management in the UK. Br J Anaesth 2011; 114-120
2. Benumof JL. Magement of the difficult adult airway. Anesthesiology 1991; 75:1087–110 3. Rowe R. An Evaluation of Virtual Reality Airway Simulator;.Anesth Analg 2002; 95: 62– 66
Centralistaion
Tissue impact
Overall _x000d_performance
ORSIM group
Centralistaion
Tissue impact
Overall_x000d_performance
Endoscopy serial no.
Endoscopy serial no.

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