Tracheoinnominate Artery Fistula.

Area of Science:

• Medical Education
• Surgical Complications
• Emergency Medicine

Background:

• Hemorrhage from a tracheoinnominate artery fistula (TIAF) is a rare, life-threatening complication of tracheostomy, with high mortality.
• Key risk factors include recent tracheostomy, percutaneous approach, prior radiation, and sentinel bleeds.

Purpose of the Study:

• To provide a simulation-based training for emergency medicine residents on the stepwise management of TIAF.
• To improve learners' ability to perform focused exams, diagnose TIAF, and implement critical interventions.

Main Methods:

• A low-fidelity manikin was modified to simulate tracheostomy site hemorrhage.
• Emergency medicine residents (PGY-1-3) participated in the simulation, with pre- and post-surveys assessing knowledge.
• Confederates role-played as a nurse and family member; a simulation technician managed vital signs.

Main Results:

• Pre- and post-simulation surveys showed a significant improvement in residents' knowledge of TIAF and tracheostomy complication management.
• The simulation effectively trained residents in critical actions like cuff hyperinflation, the Utley Maneuver, and timely surgical consultations.

Conclusions:

• Simulation is a valuable tool for teaching emergency medicine residents the management of tracheostomy emergencies like TIAF.
• Interprofessional teaching, particularly with otolaryngology, enriched the debriefing and learning experience.