Comparison of manikin models vs live sheep in ‘can’t intubate can’t ventilate’ training

Abstract

In reaching their conclusion that ‘a live sheep model appears to be a better training tool than a manikin model for all forms of cricothyroidotomy training’, Moran et al. [1] appear to have considerably lowered the bar for the animal model. They have compared the use of live sheep to a rudimentary task trainer, rather than a human cadaver or one of the validated high-fidelity manikins, the latter of which have repeatedly been shown to be superior to the use of animals for teaching this vital skill. A study published in the Journal of the American College of Surgeons compared the use of dogs and human cadavers for cricothyroidotomy training. This study found that participants misplaced 30.2% of cricothyroidotomies, when performing the procedure on live animals, compared with only 3.6% when using human cadavers [2]. Another study compared the use of the Simulab’s Trauma Man® simulator (Simulab, Seattle, WA, USA) with the use of live animals for the American College of Surgeons’ Advanced Trauma Life Support (ATLS) course, which includes cricothyroidotomy training. This study found that the simulator ‘to be superior to the animal model in teaching surgical airways’ [3]. Subsequent studies comparing the Simulab Trauma Man to animal use have found similar results [4]. Even studies examining the efficacy of low fidelity task trainers have found that ‘practice on mannequins leads to reduction in cricothyroidotomy times and improvement in success rates’ [5]. Based in part on the data presented in the Block et al. study cited above, since 2001 the American College of Surgeons has endorsed the Simulab Trauma Man (and now approves additional simulators) as a complete replacement for animal use in ATLS training. Approximately 95% of facilities offering the course in the USA use exclusively non-animal training methods. The pedagogical virtues of the anatomical specificity present in cadavers and the most well-designed simulators, the benefits of repeatability, objective feedback and skills assessment capabilities offered by modern simulators, and the ethical advantages of using non-animal training methods, all weigh heavily in favour of moving away from animal models for difficult airway training once and for all. In light of the above, endorsing the use of animals based on one study, which uses an impoverished manikin model, may be biased and also not scientific. No external funding and no competing interests declared. Previously posted at the Anaesthesia Correspondence website: http://www.anaesthesiacorrespondence.com.