Airway Training Research Articles

Modifications to the Airway Management Trainer Intubation Head for Training in Difficult Airway Recognition Through a Comparative Study With the Airsim® Intubation Head

The goal of this study was to explain some modifications to the Airway Management Trainer intubation head (case) that transform it into a difficult airway intubation head and to compare it with the Airsim intubation head (control). Eight anesthesiologists (5 experienced and 3 residents) conducted 80 endotracheal intubations each, 10 intubations with each of the 2 airway training heads under 4 distinct clinical scenarios: normal airway, macroglossia (placing a squash ball under the tongue), cervical spine rigidity (with tape placed on the cervical spine to inhibit its extension), or both macroglossia and cervical spine rigidity. We used a Macintosh laryngoscope with a #3 blade and a 7-mm (internal diameter) endotracheal tube. The outcome variables included intubation time, ease of intubation (Likert scale), glottis visualization (Cormack-Lehane scale), and the need for maneuvers for intubation. The statistical tests used were the t test and the χ test. A P < 0.05 was considered statistically significant. The intubation was more difficult in the case, but this difference was only statistically significant in normal airway and combining macroglossia and spinal rigidity, and the time of intubation was longer in the case than in the control. In the evaluation of the glottic view grade when we combined macroglossia and cervical rigidity, the case presented significantly more cases of Cormack-Lehane grade 3. The present modifications proposed for the Airway Management Trainer are easy to complete to render it similar to the Airsim for training in difficult airway management.

Impact of Difficult Airway Training on Performance of Korean Paramedic Students in Simulated Normal and Difficult Airway Scenarios: A Randomized Educational Intervention Study

Impact of Difficult Airway Training on Performance of Korean Paramedic Students in Simulated Normal and Difficult Airway Scenarios: A Randomized Educational Intervention Study

Advances in prehospital airway management.

Prehospital airway management is a key component of emergency responders and remains an important task of Emergency Medical Service (EMS) systems worldwide. The most advanced airway management techniques involving placement of oropharyngeal airways such as the Laryngeal Mask Airway or endotracheal tube. Endotracheal tube placement success is a common measure of out-of-hospital airway management quality. Regional variation in regard to training, education, and procedural exposure may be the major contributor to the findings in success and patient outcome. In studies demonstrating poor outcomes related to prehospital-attempted endotracheal intubation (ETI), both training and skill level of the provider are usually often low. Research supports a relationship between the number of intubation experiences and ETI success. National standards for certification of emergency medicine provider are in general too low to guarantee good success rate in emergency airway management by paramedics and physicians. Some paramedic training programs require more intense airway training above the national standard and some EMS systems in Europe staff their system with anesthesia providers instead. ETI remains the cornerstone of definitive prehospital airway management, However, ETI is not without risk and outcomes data remains controversial. Many systems may benefit from more input and guidance by the anesthesia department, which have higher volumes of airway management procedures and extensive training and experience not just with training of airway management but also with different airway management techniques and adjuncts.

マネキンを用いたエアウェイスコープ&lt;SUP&gt;&amp;reg;&lt;/SUP&gt;補助下経鼻気管挿管の検討

マネキンを用いたエアウェイスコープ&lt;SUP&gt;&amp;reg;&lt;/SUP&gt;補助下経鼻気管挿管の検討

An Innovative Use of an Online Procedure Logbook to Improve Airway Training among Anesthesiology Residents

We performed a single-institution pilot study to determine the potential value of an electronic logbook of airway procedures performed during a one month airway rotation for anesthesiology residents. For two years, CA-3 residents taking an advanced airway management rotation entered all airway procedures in this electronic logbook. We expected this logbook to produce results of potential use to program directors by determining the numbers of specific procedures performed by each resident. All residents taking this rotation were required to enter specific data from each airway procedure into our on-line electronic logbook. Entered information was available in tabular form to the program director and each resident. Numbers of procedures with each technique were compared among residents and to a previously determined target number of procedures for several techniques. Sixty seven residents entered data for nine specific airway procedures over a 24 month pilot study duration. When compared to target numbers of procedures for specific techniques, we discovered most residents performed less than 2 standard deviations from the target number with flexible fiberoptic intubation (usually exceeding the target number) but greater than 3 standard deviations with surgical and percutaneous procedures (usually falling short of the target number). Analysis also determined that resident experience exhibited considerable variability as shown by the ranges of several techniques. Though there was a wide range of numbers for most techniques, most were within two standard deviations of the mean values of the technique. The authors conclude that this electronic logbook was easily administered at minimal cost and administrative effort. Future studies may confirm the logbook as a feasible intervention permitting anesthesiology training programs to in crease the breadth of data related to their resident airway education.

Performance Assessment in Airway Management Training for Nonanesthesiology Trainees

Although the use of an anesthesiology "airway" rotation to train the nonanesthesiologist is commonly employed, little data exist on the utility, clinical exposure, and outcomes of these programs. A prospectively collected observational dataset of airway procedures completed by trainees in a 4-week, anesthesiology-based, airway rotation at an academic, level-1 trauma center from July 2010 to September 2012 was reviewed. Prospectively defined data points were collected through an online data tool and included patient demographics, location, date, best laryngoscopic view, and attempt details. At the authors' institution, an attending trauma anesthesiologist is present for all intubation attempts. The primary outcome was first-attempt success. A total of 4,282 self-reported, airway procedures were identified. The median number of procedures performed was 50.4 ± 13.2 (range, 20 to 93; 25th quartile = 41; 75th quartile = 57). Multivariate logistic regression analysis modeling of first-attempt success rate identified two independent predictors of success: rotation week (odds ratio, 1.42; 95% CI, 1.32 to 1.61; P < 0.0001) and number of previous intubation attempts before rotation (odds ratio, 1.23; 95% CI, 1.03 to 1.46; P = 0.02. In addition, the percentage of cases with a self-reported laryngoscopic grade 1 view increased significantly from 61 to 74% (P = 0.015) from week 1 to week 4 of the rotation. An anesthesiology-based program for airway training of nonanesthesiologists demonstrates improved self-reported, perceived first-attempt success over the course of training with improved ability to visualize glottic structures.

Board 188 - Program Innovations AbstractAirway Obstacle Course

Introduction/Background Managing an airway in an emergent situation can exacerbate the difficulty already present in potential life-threatening situations. Health professionals must not only be trained in airway management but able to critically think and communicate with team members.1,2 Current Methods used to teach initial airway management training often fail to encourage critical thinking of learners by assuming most patients and surrounding situations are the same. Less experienced healthcare professionals have been trained to use advanced airway devices but may still lack the ability to ’think outside of the box" when it comes to managing a critical patient’s airway. Most become uncomfortable when confronted with a scenario in which the Methods they were instructed to use, fail to obtain an advanced airway for the patient. Initial airway management training has become a "checkbox" for most medical and paramedic schools. Repetition of the skill is the primary focus and does not include scenarios requiring clinicians to think critically in different situations.3,4 While repetition does develop habits and in most circumstances is a key to success, critical thinking skills are extremely valuable. Critical thinking and teamwork are two competencies required of clinical professionals today.2 Routine and habits are only good when they can be used in the manner in which they were honed. Methods An advanced airway management course using simulation was developed to include critical thinking and team communication to train healthcare professionals. Scenarios were designed to provide a realistic critical patient encounter that required a "non-traditional" approach to placing an advanced airway. A secondary objective was to pair learners with different levels of healthcare training (ie. Resident, Paramedic, Nurse) together, creating an additional level of difficulty in communication and critical thinking needed. Station one: Patient was the driver of a vehicle involved in a head on crash. The only access to the patient’s airway is from above. The learner must lie on top of the roof of the car to intubate the patient. Station two: Patient is experiencing increased difficultly breathing. Patient has an atypical, which is anterior and the usual landmarks are unable to be visualized. The learner must intubate the patient without the ability to see critical landmarks. Station three: Patient was the passenger of a vehicle involved in a roll over crash. Patient is pinned upside down. The learner must crawl into the space the patient is trapped. The area is small and dark. To increase the difficulty and stress, a strobe light was added. Station four: This station is was a dual-learner station. The two learners have limited access to the patient but were able to place an advanced airway. The learners lay prone and climb into a tiered rack. The learner on the bottom has can physically preform the intubation, but not see the patient. The learner on top can see the patient but not intubate. The two leaners must work as one rescuer in order to place an advance airway. Results: Conclusion A total of 94 learners participated in the multi-scenario training. Feedback from the learners who have completed the obstacle course has been overwhelming positive, with only a few learners failing to see the value in such "extreme" airway training. Learners reported an increase in their confidence in dealing with difficult airways. Additionally, they reported an increase in their ability to critically think through each airway, as its own unique problem set. A more formal study needs to be conducted to see if this method of training has any measurable clinical impact. Further study is also needed to see if the confined space station could be used as a hybrid tool to improve inner-disciplinary communication.

Board 519 - Technology Innovations Abstract Innovative Engineering to Increase Realism in High-Fidelity Simulation? Integration of the Laerdal Medium-Fidelity Airway Manikin in Airway Management Simulation (Submission #44)

Introduction/Background The goal of High Fidelity Simulation (HFS) is to convince the participant they are immersed in a real situation. To enable HFS, we employ “Realism” in three parts; first, we insure the problem being simulated is believable (conceptual); next, we take great pain to manipulate the simulation space to appear compellingly real (physical); and finally, we insure that the communication during simulation is reflective of the event being modeled (emotionally contextual).1 Fidelity is the degree to which simulation achieves the objective of “Realism”. Realism seems to be the critical quality that enables effectiveness of High Fidelity Simulation to enable episodic memory & transformational learning. 2-4 Hence, any contribution that enhances realism - be it conceptual, physical, or contextual - is of high value at increasing the probability of HFS event to occur. We present a novel approach to HFS, whereby the integration of the Laerdal Medium Fidelity Airway Management Trainer enables enhanced conceptual and physical realism in airway management scenarios such as the bleeding tonsil, the unexpected aspirating patient and a PA rupture. Methods In all three scenarios, the High Fidelity SimMan 3G manikin is moved down the OR table and fully draped, whereby the Medium Fidelity airway head is the visible part, giving the appearance of a continuous manikin. Case One - The Bleeding Tonsil: Using fake blood loaded in the injection apparatus (see picture), we carefully position the open tip of the suction catheter in the hypopharynx of the airway trainer’s mouth, behind the tonsillar pillar. Under full drapes, a confederate will forcefully inject the fluid into the direct view of the larygoscopist, mimicking a “bleeding tonsil”. Case Two - The Aspiration Scenario: Using the same injection apparatus and fake bile, we know change the catheter tip position to the corner of the mouth. Immediately after induction, a confederate forcefully injects the fluid into the airway, whereby “bile” comes rushing out of the side of the mouth, into the mask, imitating an aspiration event. Case Three - The PA Rupture: After intubating the manikin with a short 8.0 ETT (cut to 26cm), using the same injection apparatus described above, the suction tubing is inserted up the manikin trachea, with the open catheter tip resting just past the elbow of the breathing circuit. In our simulation, when the surgeon either begins to suture in the mitral valve or during a severe protamine reaction, the red tinged fluid is injected forcefully, whereby the breathing circuit is saturated with red “blood”, mimicking a PA rupture. Results: Conclusion The ability to train for airway complications is critical to mastery of the difficult airway. Given the sensitivity to damage of expensive high fidelity equipment, it is often unfeasible to imitate the physical conditions present in certain real life situations, such as pooling blood, projectile vomit or bile, or an ett full of blood. Introducing a medium fidelity head into the HFS environment offers more flexibility to faithfully simulate the characteristic features of these scenarios, thereby enhancing the conceptual and physical realism of the learner.

Virtual airway simulation to improve dexterity among novices performing fibreoptic intubation

We developed a virtual reality software application (iLarynx) using built-in accelerometer properties of the iPhone(®) or iPad(®) (Apple Inc., Cupertino, CA, USA) that mimics hand movements for the performance of fibreoptic skills. Twenty novice medical students were randomly assigned to virtual airway training with the iLarynx software or no additional training. Eight out of the 10 subjects in the standard training group had at least one failed (> 120 s) attempt compared with two out of the 10 participants in the iLarynx group (p = 0.01). There were a total of 24 failed attempts in the standard training group and four in the iLarynx group (p < 0.005). Cusum analysis demonstrated continued group improvement in the iLarynx, but not in the standard training group. Virtual airway simulation using freely available software on a smartphone/tablet device improves dexterity among novices performing upper airway endoscopy.

Effects of Exercise Training on Airway Hyperreactivity in Asthma: A Systematic Review and Meta-Analysis

Although physical exercise is recommended for asthmatics, evidence on the effects of exercise on clinical key factors is still missing. We performed a systematic review and meta-analysis to determine the effect of exercise training (EXT) on quality of life (QoL), bronchial hyperresponsiveness (BHR), exercise-induced bronchoconstriction (EIB), lung function and exercise capacity, plus the factors affecting changes in QoL and exercise capacity in asthmatics after a period of EXT. A computerized search was conducted in MEDLINE, EMBASE, and CINAHL (last search on 15 November 2012), without language restriction, and references of original studies and reviews were searched for further relevant studies. Two independent investigators screened full-text studies with asthmatic subjects undertaking EXT (defined as training for ≥7 days, ≥2 times per week, ≥5 training sessions in total) that assessed at least one of the following outcomes: QoL, airway hyperreactivity, forced expiratory volume in one second (FEV₁), peak expiratory flow (PEF), inflammatory parameters, exercise capacity, or exercise endurance. Potentially relevant studies were excluded if only respiratory muscle training, breathing exercises or yoga was performed, if asthmatic subjects with co-morbidities were investigated, if only data of mixed patient groups without separate results for asthmatics were presented, if training regimens were not sufficiently specified, if no numerical outcome data were presented, and if new long-term medication was introduced in addition to physical training. Of 500 potentially relevant articles, 13.4 % (67 studies including 2,059 subjects) met the eligibility criteria and were included for further analyses. Data extraction and risk of bias assessment was performed according to the Cochrane Handbook for Systematic Reviews of Interventions. A meta-analysis of all randomized controlled trials (RCTs) was performed to determine the effect of EXT on asthma symptoms, BHR, EIB, FEV₁, exercise capacity and exercise endurance compared with control training. In addition, relative pre/post changes were analysed in all RCTs and controlled trials. Finally, multiple linear regression models were used to identify effects of relative changes in airway hyperreactivity (BHR or EIB), lung function (FEV₁ or PEF) and training hours on QoL and exercise performance. In a total of 17 studies including 599 subjects, meta-analyses showed a significant improvement in days without asthma symptoms, FEV1 and exercise capacity while BHR only tended to improve. The analysis of relative within-group changes after EXT showed, however, significant improvements in QoL (17 %), BHR (53 %), EIB (9 %), and FEV1 (3 %) compared with control conditions. Multiple linear regression models revealed that changes in airway hyperreactivity and lung function significantly contributed to the change in QoL, while mainly the changes in airway hyperreactivity contributed to the change in exercise capacity. EXT was shown to improve asthma symptoms, QoL, exercise capacity, BHR, EIB, and FEV1 in asthmatics and improvements in BHR explained part of the improvement in QoL and exercise capacity. Thus, physical activity should be recommended as a supplementary therapy to medication. However, more well controlled studies should be performed assessing the relationship of physical activity, QoL, airway hyperreactivity, lung function and especially airway inflammation as well as medication intake.

Needle, knife, or device – which choice in an airway crisis?

Needle, knife, or device – which choice in an airway crisis?

Face Mask Ventilation: A Comparison of Three Techniques

BackgroundThere are multiple techniques for face-mask (FM) ventilation. To our knowledge, the one-handed vs. two-handed C-E technique has been compared in children and adults, but no studies have compared the various two-handed methods. ObjectiveTo compare the effectiveness of mask seal using three different FM techniques on a model intended to simulate difficult FM ventilation and measure ventilation performance. MethodsThis was a prospective randomized study of health care providers. A standard airway-training mannequin was modified to produce variable airway resistance and allow measurements of ventilation volume and pressure. Each subject performed FM ventilation for 3 min per technique (30 breaths) in a randomized order. Median exhaled tidal volume and proximal peak flow pressure were determined and compared. ResultsSeventy subjects were enrolled. Both two-handed ventilation techniques were more effective than the one-handed technique by both volume and pressure measurements. The one-handed C-E technique yielded a median volume of 428.4 mL, vs. the two-handed C-E technique with 550.8 mL, and the two-handed V-E technique with 538 mL (p < 0.001). Peak pressure measurements revealed a median of 54.6 cm H2O for the one-handed C-E technique, 66 cm H2O for the two-handed C-E technique, and 66.6 cm H2O for the two-handed V-E technique (p < 0.001). There was not a difference between the various two-handed techniques. ConclusionsThis model for FM ventilation is able to differentiate the efficacy of FM techniques. Both two-handed ventilation methods were superior to one-handed ventilation, both of which should perhaps be included in airway training for health care providers.

Simulation‐based training in advanced airway skills in an otolaryngology residency program

Life-support training emphasizes the primacy of airway management. Acquiring these skills requires practice and exposure to events. Otolaryngology residents lack standardized training in advanced airway skills. This project aimed to create such a program by using simulation-based methodology evaluated using specific educationally based tools. Prospective cohort study. The program consisted of lectures and simulation-based training sessions designed to impart competency in a set of defined airway skills to otolaryngology residents. Only participating residents who completed the course (n = 12) were evaluated both before and after the course for their fund of knowledge through multiple-choice examinations and for clinical reasoning and technical skills as assessed by a panel of otolaryngologists in simulated difficult airway situations. Self-assessment tools were also incorporated. The average multiple choice score was 12 of 27 (44%) before the course and 15 of 27 (55%) after the completion of the course (P = .001). Faculty assessment yielded a cumulative score of 80% and 91% pre- and postcourse, respectively (P = .002). Although all residents reported prior experience in a critical emergency airway situation, only one reported prior training in advanced airway skills. A significant increase in participants' self-perceived ability to carry out critical airway-related skills was observed. All respondents felt the course was effective. Simulation-based airway training courses can be effectively incorporated into existing educational curricula for otolaryngology residents, and their success can be measured using educationally based tools. With such a course, residents can be expected to demonstrate measurable improvement in clinical knowledge base, technical skills, and self-perceived ability to handle difficult airway situations.

Using the intubating laryngeal tube in a manikin - user evaluation of a new airway device.

This work describes the use of a new intubation device, the intubating laryngeal tube (iLTA) as developed by Boedeker. Emergency Department residents and staff from the University of Nebraska Medical Center performed intubations using the Laerdal Difficult Airway Trainer Manikin(TM). The participants' perceived value of the intubating laryngeal tube as well as its efficacy in intubation performance were measured and found to be highly favorable.

Abstract 308: A Preoxygenation “Bundle” Decreases Desaturation Events and Improves Intubation Success in Air Medical Rapid Sequence Intubation

Introduction: Oxygen desaturation occurs frequently in the course of prehospital rapid sequence intubation (RSI) and has been associated with increased morbidity and mortality. Preoxygenation with positive-pressure ventilation (PPV) may delay the onset of desaturation. However, PPV may not be used aggressively with emergency RSI due to concern for gastric insufflation precipitating regurgitation and aspiration events. Objective: To evaluate an aggressive preoxygenation protocol with regard to desaturation events during air medical RSI. Methods: The RSI protocol used in our air medical program airway training model was modified to employ several interventions designed to optimize preoxygenation prior to initial laryngoscopy. These included: two-person bag-valve-mask (BVM) ventilation, “two-thumbs-up” hand positioning on the mask, correct application of cricoid pressure, aggressive use of nasopharyngeal and oropharyngeal airways, small-volume assisted ventilation prior to administration of RSI medications, and large-volume ventilation following sedation/paralysis but prior to the initial laryngoscopy attempt. This algorithm identified a target SpO2 value of at least 93% based on a previous investigation. Desaturation events [decrease in SpO2 to &lt;90% or a continued decrease by at least 2% if initial SpO2 value was &lt;90%] were identified using physiologic data exported from hand held oximeter-capnometer devices. The incidence of desaturation events was established over a 2-year period prior to and the subsequent 2-year period following implementation of these algorithm changes. Results: A total of 155 RSI procedures were evaluated over the study period. Desaturation events decreased from 58% in the two years prior to the algorithm changes to 28% in the first year and 14% in the second year following implementation (chi-square test for trend p&lt;0.01). In addition, the intubation success rate increased from 94% to 97% following implementation of the protocol. There were no reports of major aspiration events during the study period. Conclusions: An aggressive preoxygenation protocol dramatically reduced the incidence of desaturation events and increased intubation success during air medical RSI without increasing aspiration events.

Access to difficult airway equipment and training for rural GP-anaesthetists in Australia: results of a 2012 survey

In rural Australia, general practitioners (GPs) form the frontline for provision of medical services. Besides responsibilities for primary care via private practice, rural doctors often provide emergency and inpatient services for rural hospitals. The aim of this study was to determine access to difficult airway equipment and training among the GP-anaesthetist cadre in rural Australia. an online survey regarding availability of difficult airway equipment, access to ongoing training and inviting comments on rural anaesthesia in general. a questionnaire was distributed to rural doctors in January 2012 via membership databases of the Rural Doctors Association of Australia and state-based Rural Doctor Workforce Agencies. 293 participants identified as a GP-anaesthetist working in rural Australia (65% response rate). Of these 83% were male, 17% female with the percentage of respondents from each state concordant with the distributions indicated by the 2010 Rural Health Workforce National Minimum Dataset. closed-ended questions were quantified and open-ended questions analysed to determine issues relevant to GP-anaesthetists. Only 53% of GP-anaesthetists reported access to a difficult airway trolley or box in their facility. Lack of availability of certain airway equipment was reported among GP-anaesthetists, with very few having access to advanced intubation aids such as videolaryngoscopes or fibreoptic devices (flexible fibrescopes and/or malleable fibreoptic stylets). Open-ended questions suggested that GP-anaesthetists desired such aids to manage difficult airways. Only 79% had access to surgical airway or paediatric airway equipment. Of the respondents, 58% reported involvement in prehospital medicine but only 12% had received training in this challenging environment. A formal arrangement for prehospital responses existed for only 7% of respondents. Despite the existence of well-publicised algorithms for difficult airway management and the need for specific equipment to manage the difficult airway, Australian GP-anaesthetists report difficulty accessing essential equipment for these infrequent but life-threatening events. This is surprising in the light of recommendations from the Australian and New Zealand College of Anaesthetists. The consequences of difficulty in airway management can be catastrophic. Equipment needs must be balanced against important considerations including ease of use, initial and ongoing training, and cost. Suggestions for affordable equipment and ongoing training for rural GP-anaesthetists are made. The involvement of GP-anaesthetists in prehospital responses occurs in the absence of formal arrangements and with a dearth of training. There is scope to improve rural prehospital responses in Australia, utilising the advanced skills of GP-anaesthetists in resuscitation and airway management.

965 Airway Skills in Paediatric Critical Care Units; a National Survey of Non-Anaesthetic Trainees

BackgroundAirway interventions in critically ill patients are associated with a higher incidence of complications; inadequate skill can have serious implications. We conducted a survey to investigate airway skills training of...

Low‐Fidelity Simulation of Airway Emergencies

Objective: Junior trainees are commonly expected to manage airway emergencies with very little prior experience. The aim of this simulation training is to: 1) Be able to increase the confidence of participants in managing airway emergencies with respect to tracheostomies. 2) Learn the principles of performing a surgical cricothyroidomy. Method: Design: Survey. Tertiary otolaryngology center. Junior doctors otolaryngology and anaesthesia. A half-day program in managing airway emergencies. Surgical cricothyroidotomy was taught (Killick artificial larynx). Algorithms on 2 complete airway scenarios (blocked/displaced tracheostomy and “can’t intubate, can’t ventilate”) were completed. Confidence in managing airway emergencies was evaluated (Likert scale). Results: Previous exposure to airway emergencies was variable between the trainees. Universally, the trainees described a marked improvement in confidence following the practical and moulage sessions. Videos from these sessions will be available online to serve as a future teaching resource. The low-fidelity airway simulation has since been rolled out through regional hospitals led by senior residents, highlighting the utility of delivering basic airway training in a cost-effective manner. Conclusion: A low-fidelity simulation-based training of airway emergencies can be effective in improving junior otolaryngology residents’ confidence, knowledge and technical skills. Further reinforcement of clinical and decision-making skills in realistic training scenarios may be achieved through high-fidelity simulation training.

Airway Simulators and Mannequins

Airway Simulators and Mannequins

Degrees of Reality

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. 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. 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). 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.