Page 58 - Journal of Special Operations Medicine - Summer 2016

Literature Evidence on Live Animal Versus Synthetic Models for
Training and Assessing Trauma Resuscitation Procedures

Danielle Hart, MD; Mary Ann McNeil, MA; Cullen Hegarty, MD; Robert Rush Jr, MD;
Jeffery Chipman, MD; Joseph Clinton, MD; Troy Reihsen; Robert Sweet, MD

ABSTRACT

There are many models currently used for teaching and first of a series of congressionally funded research proj-
assessing performance of trauma-related airway, breath- ects aimed at improving training and assessment while
ing, and hemorrhage procedures. Although many pro- refining, reducing, and, when appropriate, replacing the
grams use live animal (live tissue [LT]) models, there is use of live animal models for these skills. 15
a congressional effort to transition to the use of non-
animal-based methods (i.e., simulators, cadavers) for Our literature review sought to examine the following
military trainees. We examined the existing literature key areas:
and compared the efficacy, acceptability, and validity of
available models with a focus on comparing LT models (1) Existing evidence for the comparative efficacy of
with synthetic systems. Literature and Internet searches current models
were conducted to examine current models for seven (2) Acceptability and validity data for the various mod-
core trauma procedures. We identified 185 simulator els. We use the term acceptability to mean whether
systems. Evidence on acceptability and validity of mod- the model is easy to use, practical, accessible, or
els was sparse. We found only one underpowered study affordable. 16
comparing the performance of learners after training (3) Evidence that currently available synthetic models
on LT versus simulator models for tube thoracostomy (i.e., simulators) could potentially replace the use
and cricothyrotomy. There is insufficient data-driven of LT for critical hemorrhage and airway/breathing
evidence to distinguish superior validity of LT or any skills.
other model for training or assessment of critical trauma
procedures. Overall validity of any one educational intervention or
assessment is dependent on multiple factors, including
Keywords: trauma; airway; hemorrhage; resuscitation; train- the type and level of learner, factors related to the as-
ing; assessment; live tissue; simulation sessors, the setting in which the test is conducted, and
the model and assessment tool used. Validity of any
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one educational intervention is dependent on the learner
level, the model, the curriculum, and the instructors.
Introduction
Our study questions focused on understanding the evi-
Recent studies from the Joint Theater Trauma Registry dence related primarily to the model used for training
have shown that severe hemorrhage accounts for 80% and assessment. Although we focus here on model-
to 90% of preventable battlefield deaths, followed by related evidence, we acknowledge that the model itself is
preventable deaths from inadequately treated tension never completely independent of the remaining aspects
pneumothoraces and airway obstruction. Cricothy- that contribute to overall validity.
1–4
rotomy studies in civilian and military populations have
found variable success and complication rates, some as Methods
low as 62% and as high as 32%, respectively. 2,5–14
PubMed and US military sources published through
A variety of models are used for training of critical hem- October 2011 were examined for articles pertinent to
orrhage and airway/breathing skills and for assessing our study questions. This initial review was performed
those skills. These include anesthetized live animals, ex to guide development of our subsequent series of pro-
vivo animal tissue, synthetic models, and virtual and spective, randomized research protocols related to train-
cadaveric models. Anatomic, physiologic, and tissue fi- ing and assessment with synthetic versus LT models in
delities vary widely. This literature review represents the the following seven core procedures: noncompressible,

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