Difficult airway research options and ethical consensus.

Abstract

In the recent editorial by Ward and Irwin addressing the ethical issues of simulating difficult airways in real patients, the term ‘consensus’ is used curiously 1. As defined in the Oxford English Dictionary 2, ‘consensus’ denotes a ‘general agreement’, and although its use in the table contained within the editorial does help to define the easily remembered CARE acronym (Consensus on Airway Research Ethics), the manner in which it is used makes it somewhat of a misnomer. That is, a ‘consensus’ usually denotes a broader general agreement, yet the editorial appears to reflect only the agreement of the sole two authors. One would usually assume agreement to be the case with authors of the same article. It implicitly (and perhaps falsely) implies a broader consensus in the area of ethics in airway research. Though I do not take issue with most of the statements contained in their CARE table–indeed, it is quite a helpful starting point for a deeper discussion on how to do difficult airway research involving real patients–for such a document to have wider acceptance (i.e. real ‘consensus’), it probably should be more broadly authored and reviewed (e.g. perhaps by representative committees of the various airway societies), before one could truly state that it represents consensus per se. Secondly, Ward and Irwin's discussion of simulation (i.e. use of manikins) vs. real patients in the teaching of difficult airway skills fails to address a potential compromise solution between real patients and airway simulators, namely the use of fresh (or lightly embalmed) 3 cadavers for simulating airway techniques. There are multiple reports of cadavers being used in various research studies and airway teaching courses 4. Although more difficult and expensive to acquire, they are devoid of the ethical concerns of using real patients and also address the lower fidelity of conventional artificial airway simulators. Before a true consensus on the ethics of difficult airway management can be made, perhaps all of the various airway training options should be considered–manikins, patients and cadavers.