Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Cardiac tamponade is a life-threatening emergency for which pericardiocentesis may be required. Real-time bedside ultrasound has obviated the need for routine blind procedures in cardiac arrest and the number of pericardiocenteses being performed has declined. Despite this fact, pericardiocentesis remains an essential skill in emergency medicine. While commercially available training models exist, cost, durability, and lack of anatomical landmarks limit their usefulness. We sought to create a pericardiocentesis model that is realistic, simple to build, reusable, and cost efficient. The model was constructed utilizing a red dye filled ping-pong ball (simulating the left ventricle) and a 250cc NS bag (simulating the effusion) encased in an artificial rib cage and held in place by gel-wax.  The inner saline bag was connected to a 1L saline bag outside of the main assembly to act as a fluid reservoir for repeat uses. The entire construction process takes approximately 16-20 hours, most of which is attributed to cooling of the gel-wax. Actual construction time is approximately 4 hours at a cost of less than $200. The model was introduced to Emergency Medicine residents and medical students during a procedure simulation lab and compared to a model previously described by dell’Orto¹. The learners performed ultrasound guided pericardiocentesis using both models.  Learners were given a survey comparing realism of the two models.  Learners felt our model was more realistic than the previously described model.  On a scale of 1-9 with 9 being very realistic, the previous model was rated a 4.5.  Our model was rated a 7.8.  There was also a marked improvement in the perceived recognition of the pericardium, the heart, and the pericardial sac. Additionally, 100% of the students were successful at performing the procedure using our model. In simulation, our model provided both palpable and ultrasound landmarks and held up to several months of repeated use. It was less expensive than commercial models ($200 vs upto $16,500) while being more realistic in simulation than other described “DIY models”.  This model can be easily replicated to teach the necessary skill of pericardiocentesis.