To design a study that enables microgravity simulation in neutral buoyancy to facilitate the development of a procedural and training protocol for cricothyrotomy in microgravity. This exploratory descriptive pilot study combines input from an expert panel with a proof-of-concept in neutral buoyancy to identify candidate methods for performing a cricothyrotomy in microgravity and to demonstrate the feasibility and safety of this simulation platform as a testbed for procedural evaluation. The expert panel concluded that the scalpel-bougie method for cricothyrotomy is the most favorable in light of current guidelines, simplicity for training of non-medical personnel, the limited payload and already available surgical tools in spaceships. Three body positions of the surgeon relative to the patient were established in which the procedure could be performed while fixating the patient, still facilitating adequate view of the neck and ease of handling the surgical tools. To ensure optimal safety, a leg-strap was developed to facilitate the fixation of surgical equipment. In addition, a retractable scalpel was implemented to minimize the risk of injury. A 3D-printed larynx model with artificial skin and cricothyroid ligament was attached to a dummy to create a simulation-patient. In neutral buoyancy, all procedural milestones were successfully reached by two participants in each of the three surgeon body positions. With the right training, measurement tools, surgery equipment and precautions, two novices were able to perform the cricothyrotomy in neutral buoyancy. The simulation platform can be used to further determine the optimal surgeon body position for cricothyrotomy in space, develop a training protocol for astronauts, and evaluate surgical performance. • Cricothyrotomy is an essential operation during long-duration spaceflight. • The scalpel-bougie method is most suitable for space applications. • A leg-strap for surgical tools and a retractable scalpel may improve safety. • Two novices safely and accurately performed the procedure in neutral buoyancy.
Nieuwenhof et al. (Fri,) studied this question.