Degrees of Reality: Airway Anatomy of High-fidelity Human Patient Simulators and Airway Trainers

Background: Human patient simulators and airway training manikins are widely used to train airway management skills to medical professionals. Furthermore, these patient simulators are employed as standardized “patients” to evaluate airway devices. However, little is known about how realistic these patient simulators and airway-training manikins really are. This trial aimed to evaluate the upper airway anatomy of four high-fidelity patient simulators and two airway trainers in comparison with actual patients by means of radiographic measurements. The volume of the pharyngeal airspace was the primary outcome parameter. Methods: Computed tomography scans of 20 adult trauma patients without head or neck injuries were compared with computed tomography scans of four high-fidelity patient simulators and two airway trainers. By using 14 predefined distances, two cross-sectional areas and three volume parameters of the upper airway, the manikins' similarity to a human patient was assessed. Results: The pharyngeal airspace of all manikins differed significantly from the patients' pharyngeal airspace. The HPS Human Patient Simulator (METI®, Sarasota, FL) was the most realistic high-fidelity patient simulator (6/19 [32%] of all parameters were within the 95% CI of human airway measurements). Conclusion: The airway anatomy of four high-fidelity patient simulators and two airway trainers does not reflect the upper airway anatomy of actual patients. This finding may impact airway training and confound comparative airway device studies.

[1]  C. Keller,et al.  Airway Management during Spaceflight: A Comparison of Four Airway Devices in Simulated Microgravity , 2000, Anesthesiology.

[2]  N. Iacovidou,et al.  Macintosh and Glidescope® performance by Advanced Cardiac Life Support providers: a manikin study. , 2011, Minerva anestesiologica.

[3]  P. Mayo,et al.  Initial airway management skills of senior residents: simulation training compared with traditional training. , 2007, Chest.

[4]  S. Russo,et al.  [Simulation and airway management]. , 2005, Der Anaesthesist.

[5]  G. Bayley,et al.  Evaluation of four manikins as simulators for teaching airway management procedures specified in the Difficult Airway Society guidelines, and other advanced airway skills * , 2007, Anaesthesia.

[6]  Peter Dieckmann,et al.  Safety culture and crisis resource management in airway management: general principles to enhance patient safety in critical airway situations. , 2005, Best practice & research. Clinical anaesthesiology.

[7]  T. Cook,et al.  Evaluation of airway equipment: man or manikin? , 2011, Anaesthesia.

[8]  R. Mihai,et al.  Litigation related to anaesthesia: an analysis of claims against the NHS in England 1995–2007 , 2009, Anaesthesia.

[9]  Z. Bismilla,et al.  Improved procedural performance following a simulation training session may not be transferable to the clinical environment , 2012, Journal of Perinatology.

[10]  Jodee Anderson,et al.  HIGH‐FIDELITY SIMULATION‐BASED TRAINING IN NEONATAL NURSING , 2004, Advances in neonatal care : official journal of the National Association of Neonatal Nurses.

[11]  T M Cook,et al.  Evaluation of four airway training manikins as patient simulators for the insertion of eight types of supraglottic airway devices * , 2007, Anaesthesia.

[12]  A I Pack,et al.  Upper airway and soft tissue structural changes induced by CPAP in normal subjects. , 1996, American journal of respiratory and critical care medicine.

[13]  A. Ziv,et al.  Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review , 2005, Medical teacher.

[14]  R. Lenoir.  Exlamation! A response to ‘Novel Airway Devices: Spoilt for Choice?’, Cook TM, Anaesthesia 2003; 58: 107–10. , 2003, Anaesthesia.

[15]  Evaluation of four airway training manikins as patient simulators for the insertion of single use laryngeal mask airways * , 2007, Anaesthesia.

[16]  T. Cook,et al.  Evaluation of four airway training manikins as simulators for inserting the LMA Classic™ * , 2006, Anaesthesia.

[17]  J B Cooper,et al.  A brief history of the development of mannequin simulators for clinical education and training , 2004, Quality and Safety in Health Care.

[18]  V. Naik,et al.  Fiberoptic Oral Intubation: The Effect of Model Fidelity on Training for Transfer to Patient Care , 2008, Anesthesiology.

[19]  C. Nargozian.  Simulation and airway-management training , 2004, Current opinion in anaesthesiology.

[20]  Vicki LeBlanc,et al.  High-Fidelity Simulation Demonstrates the Influence of Anesthesiologists' Age and Years from Residency on Emergency Cricothyroidotomy Skills , 2010, Anesthesia and analgesia.

[21]  R. Schwab,et al.  Upper airway imaging. , 1998, Clinics in chest medicine.

[22]  A. Namiki,et al.  Difficult intubation assisted by three-dimensional computed tomography imaging of the pharynx and the larynx. , 1995, Anesthesiology.

[23]  J. Laffey,et al.  A rude awakening after our fourth ‘NAP’: lessons for airway management , 2011, Anaesthesia.

[24]  V. Naik,et al.  Fibreoptic airway training: correlation of simulator performance and clinical skill , 2008, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[25]  J. Schaefer,et al.  Simulators and difficult airway management skills , 2004, Paediatric anaesthesia.

[26]  N. Kanaya,et al.  Long and Narrow Pharyngolaryngeal Passage in Difficult Airway , 2002 .

[27]  M. Schork,et al.  A study of radiologic imaging techniques and airway grading to predict a difficult endotracheal intubation. , 1995, Journal of clinical anesthesia.

[28]  R. Hesselfeldt,et al.  Evaluation of the airway of the SimMan™ full‐scale patient simulator , 2005, Acta anaesthesiologica Scandinavica.

[29]  S. Russo,et al.  Simulation und Atemwegsmanagement , 2005, Der Anaesthesist.

[30]  H. Chou,et al.  Long and narrow pharyngolaryngeal passage in difficult airway. , 2002, Anesthesia and analgesia.

[31]  H. Groeben,et al.  Laryngoscopy via Macintosh Blade versus GlideScope: Success Rate and Time for Endotracheal Intubation in Untrained Medical Personnel , 2009, Anesthesiology.

[32]  T. Cook,et al.  Novel Airway Devices: Spoilt for Choice? , 2003, Anaesthesia.

[33]  H. Chou,et al.  Large hypopharyngeal tongue: a shared anatomic abnormality for difficult mask ventilation, difficult intubation, and obstructive sleep apnea? , 2001, Anesthesiology.

[34]  Helmut Ringl,et al.  A comparison of paediatric airway anatomy with the SimBaby high-fidelity patient simulator. , 2011, Resuscitation.

[35]  G. Clark,et al.  Gender- and age-based differences in computerized tomographic measurements of the orophaynx. , 2008, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[36]  J. Walker,et al.  Evaluation of airway equipment: man or manikin? , 2011, Anaesthesia.

[37]  P. Bradley.  The history of simulation in medical education and possible future directions , 2006, Medical education.

[38]  G. Maislin,et al.  State-related changes in upper airway caliber and surrounding soft-tissue structures in normal subjects. , 1998, American journal of respiratory and critical care medicine.

[39]  T. Niiya,et al.  The utility of three-dimensional computed tomography in unanticipated difficult endotracheal intubation. , 2000, Anesthesia and analgesia.

[40]  M F El-Khatib,et al.  Tracheal intubation following training with the GlideScope® compared to direct laryngoscopy , 2010, Anaesthesia.

[41]  T. Cook,et al.  Litigation related to airway and respiratory complications of anaesthesia: an analysis of claims against the NHS in England 1995–2007 , 2010, Anaesthesia.