Airway Manikin Research Articles

Caring for manikins

Whilst attending the recent meeting of the Difficult Airway Society in Dublin I heard a paper on the use of various new airway devices, all of which had been tried on airway simulation manikins. The author mentioned that Ethics Committee approval had been sought and granted prior to the start of the study. During discussion of the paper the need for ethics approval for manikin studies was questioned and a senior member of the profession stated that the approval was for the protection of the volunteers involved in the study and that the manikins do not need protection! I was shocked by this attitude and in the interest of, and on behalf of these selfless manikins, I intend to set up an organisation to defend their interests. I appeal to all like minded humanitarian (or should it be manikiniterian?) anaesthetists to join my newly formed Society for the Protection of Airway Manikins, to be known as SPAM.

Evaluation of a Novel Animal Model for Teaching Intubation

Background: Medical colleges, which face dwindling financial resources, are often forced to rely on inexpensive means of providing students with relevant learning opportunities. Purposes: In this article, we present an evaluation of a novel animal model to be used to teach medical students, resident physicians, and allied health personnel advanced airway management skills, namely, endotracheal intubation. Methods: Over 3 years of regularly scheduled teaching laboratories, 140 students had exposure to both a traditional teaching manikin and a whitetail deer head on which to learn rescue airway techniques. We measured participants on successfully completing an intubation, and we timed them to determine length of time to complete it. Participants also rated the experience across a variety of dimensions. Results: Students reported being very satisfied with the learning experience and were able to perform the techniques more quickly and accurately using the animal model. Conclusions: The deer airway model is superior to the manikin airway model in teaching endotracheal intubation to students. It should be considered as a viable alternative in medical education settings.

(Still) time to organise training in airway management in the UK

(Still) time to organise training in airway management in the UK

Evaluation of four airway training manikins as simulators for inserting the LMA Classic™*

Airway manikins have traditionally been used for teaching mask ventilation and tracheal intubation. There is an increasing need to use manikins for training in procedures such as insertion of the laryngeal mask airway. We have assessed four new airway training manikins (latest versions of the Airway Trainer (Laerdal, Norway), Airway Management Trainer (Ambu, UK), 'Bill 1' (VBM, Germany) and Airsim (Trucorp, Ireland)) as simulators for insertion of the LMA Classic laryngeal mask airway. Twenty volunteer anaesthetists inserted a size-4 laryngeal mask airway five times into each of the four manikins, in random order. Each insertion was assessed using objective and subjective tests. Subjective assessment varied widely but overall assessment indicated that the Airway Management Trainer was the poorest simulator for insertion of the laryngeal mask airway. The 'Bill 1' and Airsim manikins performed best as simulators for insertion of the laryngeal mask airway, although realistic ventilation with 'Bill 1' was not possible.

A randomized controlled trial on the effect of educational interventions in promoting airway management skill maintenance

Study Objective: This study was conducted to determine the natural history of airway management skill decay and examine the effect of independent practice and periodic feedback on airway management skill maintenance. Methods: This prospective, randomized controlled study conducted at Dalhousie University in Halifax, Nova Scotia, Canada, between November 1997 and September 1998. A convenience sample of 84 health sciences students with no prior airway management experience was used. Participants were trained using an advanced airway manikin and then were randomly assigned to control (n=24), periodic feedback only (n=30), and independent practice plus periodic feedback (n=30) groups. Performance was measured by a 52-point weighted checklist at 0, 16, 25, and 40 weeks after the initial program. Results: Group scores were analyzed using a mixed-model repeated-measures analysis of variance and Bonferroni-adjusted P values. Overall group (P =.0002) and time (P =.0001) effects were significant. At time 0, there was no statistical difference in mean scores between groups (range 45.0 to 45.2). Control group performance fell over the first time interval (0 to 16 weeks) (mean score=34.0, P =.002) and remained lower at all intervals without further significant change. Scores in the independent practice plus feedback group revealed no significant changes over time and were significantly higher than the control group throughout. Performance in the periodic feedback only group showed a nonsignificant trend to improved performance over the control group. Conclusion: Airway management skill performance declines early after initial training. Independent practice combined with periodic feedback was effective in maintaining performance scores in an advanced airway management simulation. Periodic evaluation with feedback alone showed a nonsignificant trend toward improvement over control. [Kovacs G, Bullock G, Ackroyd-Stolarz S, Cain E, Petrie D. A randomized controlled trial on the effect of educational interventions in promoting airway management skill maintenance. Ann Emerg Med. October 2000;36:301-309.]

Prehospital Oral Endotracheal Intubation by Rural Basic Emergency Medical Technicians

Study objective: To determine whether basic emergency medical technicians (EMT-B) can perform prehospital oral endotracheal intubation with success rates comparable to those of paramedics.Methods: This was a nonrandomized, controlled trial using historical controls. Seven basic life support emergency medical services systems in six counties and their corresponding emergency departments in rural Indiana participated. Eighty-seven full-time EMTs with no prior or concurrent paramedic training volunteered for intubation training. Apneic prehospital patients aged 16 years or older without an active gag reflex or massive facial trauma were eligible for intubation and study enrollment. The EMTs completed a 9-hour didactic and airway manikin training course in direct laryngoscopic endotracheal intubation. The course was adapted from the national paramedic curriculum.Results: Thirty-four (39%) of the EMT-Bs attempted to intubate 57 eligible patients. In 49.1% of these patients, successful endotracheal tube placement was confirmed by the receiving physician (95% confidence interval, 36.4% to 61.9%); in contrast, the prehospital intubation success rates from three previous studies of manikin-trained paramedics ranged from 76.9% to 90.6% (P<.001). Complications included five (9%) inadvertent extubations, two endotracheal tube cuff ruptures, two prolonged intubation attempts, and one mainstem bronchus intubation. There were no unrecognized esophageal intubations. Two of the seven EMS agencies did not report any intubation data.Conclusion: Rural EMTs with didactic and airway manikin training failed to achieve prehospital intubation success rates comparable to those of paramedic controls. Possible explanations include training deficiencies, poor skill transference from manikin to human intubation, infrequent intubation experiences, and inconsistent supervision.[Bradley JS, Billows GL, Olinger ML, Boha SP, Cordell WH, Nelson DR: Prehospital oral endotracheal intubation by rural basic emergency medical technicians. Ann Emerg Med July 1998;32:26-32.]

A breathing manikin model for teaching nasotracheal intubation to ems professionals

Objective. The widespread use of orotracheal intubation with rapid-sequence induction has made it difficult for emergency medical services (EMS) professionals to gain experience in nasotracheal intubation (NTI) in a controlled and supervised setting. The purpose of this study was to determine whether a training session on NTI with a breathing manikin can be used to improve the self-assessed skill level and comfort of EMS professionals.Methods. A prospective trial was conducted with a convenience sample of 33 EMS professionals, previously trained in NTI techniques. For the training session, a Laerdal airway manikin was modified by replacing the lungs with self-inflating resuscitation bag. The bag could then be squeezed to simulate breathing, with an inspiratory and expiratory phase. Following didactic instruction, and with direct supervision, each participant practiced NTI using this breathing manikin. Each participant completed a questionnaire, both before and after the training session, to determine self-assessed comfort and skill level for both oral and nasal intubations (0 = lowest, 10 = highest). The pre- and postintervention scores were compared using the Wilcoxon signed-rank test, alpha = 0.01.Results. Following the training session, the comfort level for NTI by the participants increased significantly from a median value of 2 to 7 (p = 0.001). Furthermore, the self-assessed skill level for NTI following the training session increased significantly from a median value of 4 to 8 (p = 0.0001). As expected, there were no significant differences noted in self-assessed skill level for orotracheal intubation following the training session. However, there was statistically significant improvement in self-assessed comfort levels for orotracheal intubation after the skills laboratory, p = 0.0001.Conclusion. For EMS professionals, a training session for NTI using a relatively inexpensive and easily assembled breathing manikin model increases both comfort and self-assessed skill level.

19. A Breathing Manikin Model for Teaching Nasotracheal Intubation to EMS Professionals

Purpose: The wide spread use of orotracheal intubation with rapid sequence induction has made it difficult for EMS professionals to gain experience in nasotracheal intubation (NTI) in a controlled supervised setting. The purpose of this study was to determine if a training session on NTI with a breathing manikin can be used to improve skill and comfort of EMS professionals.Methods: A prospective trial was conducted with a convenience sample of 16 emergency medical service professionals, previously trained in nasotracheal intubation techniques. For the training session a Laerdal airway manikin was modified by replacing the lungs with a bag-valve mask device, to simulate breathing with an inspiratory and expiratory phase. Following verbal instruction, and with direct supervision, each participant practiced NTI using the breathing manikin. Each participant completed a questionnaire, both before and after the training session, to determine self assessed comfort and skill level for both oral and nasal intubations (0 = lowest, 10 = highest). The pre and post intervention scores were compared using the Wilcoxon signed-rank test, £ = 0.01.