International Journal of Healthcare Simulation

Background:

Neck haematomas are a recognised complication of thyroid surgery. In the most severe events, the haematoma can compromise the airway resulting in hypoxic brain injury or death. While experienced members of the surgical team may be confident in dealing with these complications, others in the multidisciplinary team may require additional training to familiarise themselves with correct emergency procedures. These complications are relatively infrequent, presenting in 1–2% of thyroid surgery patients [1], meaning there are limited opportunities for less experienced staff to learn from real life examples. A simulation-based teaching session was developed by members of the surgical and simulation teams and showed positive results in multidisciplinary training. The teaching was based around a task-training manikin that could be easily transported allowing for training and demonstrations to be delivered away from the simulation centre.

Methods:

The technique for evacuating post-thyroidectomy neck haematomas can be remembered using the mnemonic ‘SCOOP’:

1. Skin exposure

2. Cut sutures

3. Open skin

4. Open muscles

5. Pack Wound.

To simulate this effectively, we created a silicone wound that simulated skin, strap muscles, and a silicone and jelly haematoma, with attached tubing to simulate venous bleeding. This was attached to an old CPR demonstration and practice manikin at the neck (Figure 1). This manikin was supplemented by a laptop and tablet running simulation software, allowing us to simulate patient observations. We also placed a waterproof Bluetooth speaker inside the manikin, linked to a phone used by the simulation operator, to allow for speech and other sounds.

Figure 1:

Image showing the task trainer in use, demonstrating the SCOOP procedure as the candidate cuts the sutures to access the simulated neck haematoma.

Results:

Sessions have taken place in the simulation centre and as an in-situ workstation, reaching 70 participants. Course participants at the simulation centre completed a post-course questionnaire where 21 out of 27 attendees had improved levels of confidence in recognising airway complications and 26 out of 27 had improved confidence managing neck haematoma with compromised airway. Feedback from the in-situ teaching has been very positive.

Conclusion:

The delivery of training around SCOOP and complications post-thyroidectomy surgery is now recommended in guidelines from the Difficult Airway Society [2], the British Association of Endocrine, and Thyroid Surgeons and the British Association of Otorhinolaryngology [3]. This relatively low-cost solution allows for the delivery of training for multidisciplinary surgical ward staff in a safe environment that will improve the confidence of the trainees in dealing with the recognition and management of a life-threatening emergency.

References

1. Doran HE, Wiseman SM, Palazzo FF, Chadwick D, Aspinall S. Post-thyroidectomy bleeding: analysis of risk factors from a national registry. British Journal of Surgery. 2021;108(7):851–857.

2. Iliff HA, El‐Boghdadly K, Ahmad I, Davis J, Harris A, Khan S, Lan‐Pak‐Kee V, O’Connor J, Powell L, Rees G, Tatla TS. Management of haematoma after thyroid surgery: systematic review and multidisciplinary consensus guidelines from the Difficult Airway Society, the British Association of Endocrine and Thyroid Surgeons and the British Association of Otorhinolaryngology, Head and Neck Surgery. Anaesthesia. 2022;77(1):82–95.

3. Management of post-operative haemorrhage in thyroid and parathyroid surgery – British Association of Endocrine and Thyroid Surgeons (BAETS) – https://www.baets.org.uk/management-of-post-operative-haemorrhage-in-thyroid-and-parathyroid-surgery/ [Accessed on 21/06/2022]