Journal of Education and Teaching in Emergency Medicine

Audience: The gastrostomy-assisted simulated pneumothorax (GASP) model is designed to train residents in emergency medicine, anesthesiology, pulmonology, cardiothoracic surgery, and paediatric surgery in the various techniques used to perform chest drainage (CD).

Introduction: Pneumothorax is a life-threatening emergency, particularly in the case of a tension pneumothorax. Failure to perform timely CD can rapidly result in cardiorespiratory arrest.¹ Needle decompression, chest tube insertion, and finger thoracostomy are the three main CD procedures that healthcare professionals must master. However, these are technically challenging procedures with potentially severe and sometimes fatal complications. The literature reports significant complication rates (19%) and failure rates (18-21%).^2,3

Synthetic simulators for CD are commonly used in simulation centres due to their availability. While they are useful in the early stages of training to teach the fundamental steps of the procedure, they lack realism, are expensive, and do not provide the tactile feedback essential for safe and effective performance. The GASP model was developed to provide a realistic, easily reproducible, and accessible pneumothorax simulation tool aimed at improving CD training for medical trainees.

Educational Objectives: By the end of this educational session using the GASP model, learners should be able to: 1) identify the two main thoracic anatomical landmarks commonly used in clinical practice for CD: the second intercostal space at the midclavicular line, and the fifth intercostal space at the midaxillary line, 2) become familiar with the tactile sensation of palpating the superior border of the rib, a key landmark for directing the chest tube safely and with the correct angulation, 3) mastering the three main techniques of CD: needle decompression, chest tube insertion, and finger thoracostomy, and 4) demonstrate proficiency while performing the procedure within a complex simulation scenario.

Educational Methods: The GASP model utilises fresh cadavers prepared with an insufflation device and a gastrostomy button to simulate pneumothorax or haemopneumothorax. Manual or automated ventilation may be added to enhance realism. This model can be used to teach residents how to perform the three main CD procedures effectively and safely. Each learner can perform multiple repetitions on each cadaver.

Research Methods: At the Institute of Anatomy and Surgical Simulation (IASC) in Toulouse, France, 10 fresh cadavers preserved by refrigeration were used for this study. Each donor had provided informed and written consent during their lifetime for the use of their body in experimental research. Demographic data related to the cadavers, such as age, sex, and body mass index, were collected. 

The GASP model was tested on 20 hemithoraces from the 10 cadavers. The presence and quality of the pneumothorax were assessed via ultrasound by an experienced radiologist. The two main CD approaches commonly used in clinical practice (axillary and anterior) were tested, along with several CD techniques: needle decompression, direct insertion using a Pleurocath^® drain and Monod trocar, the Seldinger technique with a Fuhrman-Cook drain, and finger thoracostomy. 

The GASP model was subsequently introduced to first-year residents in anesthesiology, emergency medicine, and pulmonology. Participants used Likert scales to evaluate the model’s realism, its transferability to clinical practice, and its overall educational value. Additionally, the study assessed learners' perceived self-efficacy and the level of discomfort associated with performing simulations on cadaveric specimens.

Results: In all 20 hemithoraces (10 right and 10 left), a large pneumothorax was confirmed by ultrasound. All major CD techniques were successfully performed, using a variety of drainage devices appropriate to different clinical scenarios. The model provided a realistic simulation of the procedure, offering the same tactile sensation as on a live patient. It enabled repeated CD in each hemithorax (exceeding 40 procedures per side) without compromising the structural integrity of the model.

Eight first-year residents (from anesthesiology, emergency medicine, and pulmonology) were enrolled in the first CD course on cadaver-based training at our faculty, using the GASP model. Pre- and post-training assessments based on 10-point questionnaires demonstrated significant improvements in baseline confidence in technical skills, stress management, and overall performance. The GASP model was also evaluated by participants using a 5-point Likert scale, revealing high levels of realism, strong transferability to patient care, and increased perceived self-efficacy among learners. Finally, the cadaveric model was associated with minimal discomfort for participants.

Discussion: The GASP model is realistic, easy to implement, reproducible, low-cost, and reusable multiple times. It serves as a valuable tool for enhancing skill acquisition among a wide range of healthcare professionals who need to master this procedure, providing a level of tactile realism that is often lacking in synthetic models. Its successful integration within our medical simulation centre supports the development of additional cadaveric simulation models for other emergency procedures.