Comparison of videolaryngoscopy alone with video-assisted fibreoptic intubation in a difficult cadaver airway model.

ABSTRACT: No Abstract.

Suitability and realism of the novel Fix for Life cadaver model for videolaryngoscopy and fibreoptic tracheoscopy in airway management training.

BACKGROUND: Videolaryngoscopy is increasingly advocated as the standard intubation technique, while fibreoptic intubation is broadly regarded as the 'gold standard' for difficult airways. Traditionally, the training of these techniques is on patients, though manikins, simulators and cadavers are also used, with their respective limitations. In this study, we investigated whether the novel 'Fix for Life' (F4L) cadaver model is a suitable and realistic model for the teaching of these two intubation techniques to novices in airway management. METHODS: Forty consultant anaesthetists and senior trainees were instructed to perform tracheal intubation with videolaryngoscopy and fibreoptic tracheoscopy in four F4L cadaver models. The primary outcome measure was the verbal rating scores (scale 1-10, higher scores indicate a better rating) for suitability and for realism of the F4L cadavers as training model for these techniques. Secondary outcomes included success rates of the procedures and the time to successful completion of the procedures. RESULTS: The mean verbal rating scores for suitability and realism for videolaryngoscopy was 8.3 (95% CI, 7.9-8.6) and 7.2 (95% CI, 6.7-7.6), respectively. For fibreoptic tracheoscopy, suitability was 8.2 (95% CI, 7.9-8.5) and realism 7.5 (95% CI, 7.1-7.8). In videolaryngoscopy, 100% of the procedures were successful. The mean (SD) time until successful tracheal intubation was 34.8 (30.9) s. For fibreoptic tracheoscopy, the success rate was 96.3%, with a mean time of 89.4 (80.1) s. CONCLUSIONS: We conclude that the F4L cadaver model is a suitable and realistic model to train and teach tracheal intubation with videolaryngoscopy and fibreoptic tracheoscopy to novices in airway management training.

Comparison of a Novel Cadaver Model (Fix for Life) With the Formalin-Fixed Cadaver and Manikin Model for Suitability and Realism in Airway Management Training.

BACKGROUND: Manikins are widely used in airway management training; however, simulation of realism and interpatient variability remains a challenge. We investigated whether cadavers embalmed with the novel Fix for Life (F4L) embalmment method are a suitable and realistic model for teaching 3 basic airway skills: facemask ventilation, tracheal intubation, and laryngeal mask insertion compared to a manikin (SimMan 3G) and formalin-fixed cadavers. METHODS: Thirty anesthesiologists and experienced residents ("operators") were instructed to perform the 3 airway techniques in 10 F4L, 10 formalin-fixed cadavers, and 1 manikin. The order of the model type was randomized per operator. Primary outcomes were the operators' ranking of each model type as a teaching model (total rank), ranking of the model types per technique, and an operator's average verbal rating score for suitability and realism of learning the technique on the model. Secondary outcomes were the percentages of successfully performed procedures per technique and per model (success rates in completing the respective airway maneuvers). For each of the airway techniques, the Friedman analysis of variance was used to compare the 3 models on mean operator ranking and mean verbal rating scores. RESULTS: Twenty-seven of 30 operators (90%) performed all airway techniques on all of the available models, whereas 3 operators performed the majority but not all of the airway maneuvers on all models for logistical reasons. The total number of attempts for each technique was 30 on the manikin, 292 in the F4L, and 282 on the formalin-fixed cadavers. The operators' median total ranking of each model type as a teaching model was 1 for F4L, 2 for the manikin and, 3 for the formalin-fixed cadavers (P < .001). F4L was considered the best model for mask ventilation (P = .029) and had a higher mean verbal rating score for realism in laryngeal mask airway insertion (P = .043). The F4L and manikin did not differ significantly in other scores for suitability and realism. The formalin-fixed cadaver was ranked last and received lowest scores in all procedures (all P < .001). Success rates of the procedures were highest in the manikin. CONCLUSIONS: F4L cadavers were ranked highest for mask ventilation and were considered the most realistic model for training laryngeal mask insertion. Formalin-fixed cadavers are inappropriate for airway management training.