Emergency access to the subclavian vessels by non-thoracic surgeons: a cadaver-based learning model for orthopedic trauma surgery

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PURPOSE: The aim of this study was to evaluate the procedural time and safety of an infraclavicular approach to the subclavian vessels for damage control of major upper extremity vascular injuries. The study specifically focused on the performance of non-thoracic surgeons using a cadaveric model. METHODS: A sample of 100 orthopedic trauma surgeons (residents, specialists, and attendings) was recruited from an AO cadaveric dissection course. Emergency infraclavicular access was performed on 50 cadavers over two consecutive days. The procedural time, successful vessel clamping, participant self-assessment, and the resulting learning curve were analyzed. RESULTS: On day one, 27% (9/33) of participants who successfully achieved correct clamping of both subclavian vessels reported feeling confident. By day two, this proportion increased to 71% (55/77). Comparing day 1 to day 2 we found an improvement of 35% (subclavian artery) and 37% (subclavian vein) in the correct identification of subclavian vessels in our sample. The evaluations of this study show that there is no correlation between surgical experience and successful emergency access. CONCLUSION: Anatomic dissection is of paramount importance for teaching rare and demanding surgical techniques. This study demonstrates that anatomical workshops significantly improve procedural safety and self-assessment when accessing subclavian vessels during emergencies.

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