title: The S.T.A.B. trial-standardized testing of artificial blood: a comparative study of various products that may be used as artificial blood for high fidelity simulation training in the critical care setting.
abstract: OBJECTIVE
  In the current climate of medical education, there is an ever-increasing demand for and emphasis on simulation as both a teaching and training tool. The objective of our study was to compare the realism and practicality of a number of artificial blood products that could be used for high-fidelity simulation.
  
  
  METHODS
  A literature and internet search was performed and 15 artificial blood products were identified from a variety of sources. One product was excluded due to its potential toxicity risks. Five observers, blinded to the products, performed two assessments on each product using an evaluation tool with 14 predefined criteria including color, consistency, clotting, and staining potential to manikin skin and clothing. Each criterion was rated using a five-point Likert scale. The products were left for 24 hours, both refrigerated and at room temperature, and then reassessed. Statistical analysis was performed to identify the most suitable products, and both inter- and intra-rater variability were examined.
  
  
  RESULTS
  Three products scored consistently well with all five assessors, with one product in particular scoring well in almost every criterion. This highest-rated product had a mean rating of 3.6 of 5.0 (95% posterior Interval 3.4-3.7). Inter-rater variability was minor with average ratings varying from 3.0 to 3.4 between the highest and lowest scorer. Intrarater variability was negligible with good agreement between first and second rating as per weighted kappa scores (K = 0.67).
  
  
  CONCLUSIONS
  The most realistic and practical form of artificial blood identified was a commercial product called KD151 Flowing Blood Syrup. It was found to be not only realistic in appearance but practical in terms of storage and stain removal.
authors.affiliation: Prince Charles Hospital (S.F., M.H., M.Z., C.F.), Chermside, QLD, Australia. sfahyfirstmed@yahoo.com
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Fahy
authors.forename: Daniel
authors.initials: D
authors.lastname: Host
authors.forename: Dylan
authors.initials: D
authors.lastname: Campher
authors.forename: Lucas
authors.initials: L
authors.lastname: Tomczak
authors.forename: Kim
authors.initials: K
authors.lastname: Vidhani
authors.forename: Maria
authors.initials: M
authors.lastname: Higgs
authors.forename: Adrian
authors.initials: A
authors.lastname: Barnett
authors.forename: Marc
authors.initials: M
authors.lastname: Ziegenfuss
authors.forename: Carole
authors.initials: C
authors.lastname: Foot
mesh_terms: D001802:Blood Substitutes; D003198:Computer Simulation; D003422:Critical Care / Q000379:methods*; D004501:Education, Medical / Q000379:methods*; D006801:Humans; D008348:Manikins; D015588:Observer Variation
chemical_list: D001802:Blood Substitutes