Innovative artificial lesions to mimic difficult airway pathology in cadavers, supporting airway management training

Abstract

BackgroundClinicians working in anesthesiology or critical care medicine often face difficult airway situations. Moreover, time is limited to make the right decisions while securing the airway for critically ill patients. Although the modern airway management approach is strategy-based, it remains essential to provide an adequate level of training to acquire technical skills. Cadaver-based skill training is considered to be one of the highest levels of education. AimUsing an innovative method we aimed to create realistic artificial lesions making airway management difficult on specially soft-fixed human preparations. MethodsWe produced submucosal upper and lower airway lesions by injecting green-coloured liquid silicone. First, 10 non-fixed human head and neck visceral complexes were injected by suprahyoidal, infrahyoidal or transcricothyroidal lateral punctures. After the silicone crosslinked, the preparations were fixed (4% formaldehyde) and the lesions were visualized by sections. Then in situ lesions were implanted by percutaneous puncture of 5 Thiel-fixed head preparations. Tracheal stenosis was achieved by external ligature. Videolaryngoscopic images were taken under comparable parameters before and after implantation. ResultsThe lesions created proved to be realistic in their localisation and shape. The tissues were optimally infiltrated and not fragile. In the in situ models significant airway stenoses and anatomical deformities were induced. ConclusionAs first step of a long-term project the current paper has only attempted to communicate modelling as a technical report on creating standardized artificial airway difficulties for education or research. Our models provide an opportunity to increase the anatomical diversity and realism of airway management courses. A systematically designed educational unit consisting of several cadavers is an invaluable tool in training, the role of which is planned to be analyzed.