Page 83 - JSOM Spring 2025

BOX 4 Post-technique Damage Scoring System 16 the emergent surgical airway technique in canines. Although
not statistically significant, the MD group completed both
Score Description CTT and TT in less time when compared with the DVM
0 No gross damage. group. However, the MD group had an average of 2 years of
1 Minor damage (e.g., tracheal abrasions, scratches, experience practicing medicine, while four out of five experi-
off-midline incision, and minor laceration of muscle
<5mm). menters in the DVM group consisted of new graduates with
2 Moderate damage (e.g., dorsal tracheal lesions, partial less than 1 year of clinical experience practicing veterinary
thickness mucosal laceration <5mm, laceration of medicine. The shorter procedure times for the MD group most
muscle >5mm, and deformation of tracheal rings). likely reflect their greater exposure to surgical procedures and
3 Severe damage (e.g., full-thickness tracheal tear, tissue handling skills when compared with the DVM group.
tracheal ring or cricoid cartilage fracture, esophageal Considering the VCO with approximately 5 years of clinical
tear, and incision between tracheal rings greater than experience performed CTT in 20 seconds, this supports the
half the circumference of the trachea).
notion that prior surgical experience played a role in the time
to complete the techniques.
1.4 [SD 1.140] vs. MD: 0, P<.05). Interestingly, the mean dam-
age score for both groups performing TT was the same with
no statistically significant differences (1.6 [0.894] score). In The speed at which the MD group performed CTT on a novel
the MD group, the TT damage score was statistically higher patient model supports the direct translation of their knowl-
than the CTT damage score (CTT: 0 vs. TT: 1.6 [SD 0.894], edge and skills for performing CTT in people to performing it
P<.01). There was no statistical difference between the dam- on MWDs. The MD group took longer to complete TT when
age scores of CTT and TT in the DVM group (CTT: 1.4 [SD compared with CTT. The group’s increased length of time to
1.140] vs. TT: 1.6 [0.894]; Figure 1B). complete TT may be due to the MD group’s unfamiliarity
with the TT technique as well as the novelty of the canine
model. Additional training on the TT technique could help
Participants’ Responses to the Questionnaire
Overall, comparing the rate of responses to the questionnaire, increase the MD group’s technical skill proficiency allowing
most of the responses followed a similar trend (Box 5); for ex- for both a reduction in overall procedure time and inadver-
ample, if DVM agreed with a question for the CTT procedure, tent tissue trauma. Even though the DVM group completed
MD also agreed. The responses to the questionnaire for the TT TT in less time when compared with CTT, the majority of
procedure varied between the MD and DVM groups more than the DVM group reported that CTT was not complex, was an
the responses to the CTT procedure; however, the MD group easy technique to use, and did not feel significant instructions
had on average larger SDs compared to the DVM group (av- were needed prior to using the technique. The fact that veter-
erage SDs: MD-TT 1.06, DVM-TT 0.83; Figure 2). Within the inarians are taught and, therefore, familiar with performing
MD group, most of the answers for the CTT procedure had TT in their professional curriculum could account for the
small SDs (average SDs: 0.48), with many answers in the high- shorter time the DVM group took to perform TT compared
est or lowest available scores, which represent “strongly agree” to CTT.
and “strongly disagree.” The responses from the DVM group
for both procedures had similar distribution and SDs (average Damage to the airway and overlying structures varied between
SDs: CTT 0.88, TT 0.83). The DVM group had a wider range the MD and DVM groups and between the CTT and TT tech-
of answers to the CTT procedure than the MD group. niques. The MD group and the VCOs with at least 5 years of
clinical experience did not cause gross damage to the trachea,
Discussion surrounding muscles, or esophagus while performing CTT. On
the other hand, all of the four less experienced VCOs caused
This pilot study demonstrated an overall positive experience some damage to the airway and surrounding structures during
from both the MD group and DVM group for using CTT as CTT. Lack of technical confidence when performing surgical

FIGURE 1 Procedure completion time and damage scores by procedure and group.

(A) (B)

DVM = veterinarians; CTT = cricothyrotomy; MD = emergency physician residents; TT = tube tracheostomy
*P <.05.
**P <.01.

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