Anatomic accuracy of airway training manikins compared with humans*

Abstract

Summary Airway simulators, or training manikins, are frequently used in research studies for device development and training purposes. This study was designed to determine the anatomic accuracy of the most frequently used low‐fidelity airway training manikins. Computerised tomography scans and ruler measurements were taken of the SynDaver®, Laerdal® and AirSim® manikins. These measurements were compared with human computerised tomography (CT) scans (n = 33) from patients at the University of Michigan Medical Center or previously published values. Manikin measurements were scored as a percentile among the distribution of the same measurements in the human population and 10 out of 27 manikin measurements (nine measurements each in three manikins) were outside of two standard deviations from the mean in the participants. All three manikins were visually identifiable as outliers when plotting the first two dimensions from multidimensional scaling. In particular, the airway space between the epiglottis and posterior pharyngeal wall, through which airway devices must pass, was too large in all three manikins. SynDaver, Laerdal and AirSim manikins do not have anatomically correct static dimensions in relation to humans and these inaccuracies may lead to imprecise airway device development, negatively affect training and cause over‐confidence in users.

Anatomic accuracy, physiologic characteristics, and fidelity of very low birth weight infant airway simulators

“…19 A research group led by Cook and colleagues 9 , 26 , 27 found evidence that devices performed differently depending on the type of simulator used. Blackburn et al 18 compared the anatomic accuracy of adult airway training manikins with humans and identified relevant inaccuracies in static dimensions. They concluded that this observation might imprecise airway device development, negatively affect training, and cause over-confidence in users.…”

“…Several studies analyzed the anatomic accuracy of adult simulators, comparing them with humans. 18 – 20 They showed that some simulators suffered from significant inaccuracies with incorrect airway dimensions, which may negatively affect training and cause over-confidence in users. Sawyer et al 21 analyzed the fidelity of eight neonatal airway simulators through expert review and found significant differences in expert ratings.…”

A Novel Airway Opening Device with Automatic Position Adjustment

“…However, further researches need to be conducted to evaluate its e cacy and safety in clinical patients. Since the 1960s, human manikins have been used to teach and train people's techniques in airway management and CPR, but there are some differences in airway anatomy and mechanics between the real patients and human models 18,19 . The main differences are the cervical spine mobility, airway resistance, and anatomical proportions, especially the airspace of pharyngeal and retropalatal of human models are wider than the real patients 20,21 .…”

Simulation-based airway research: The fast-track recipes?

“…[ 16 ] Manikins can become stiff and non- compliant. [ 17 ] It is said that the manikin’s anatomy, material compliance and haptic qualities can affect the forces exerted by the distal laryngoscope blade during laryngoscopy and intubation. [ 12 18 ] Researchers have measured forces applied during laryngoscopy in different manikins, cadavers and humans with the help of strain gauges and sensors attached to the laryngoscope handle or blade.…”

“…The airway space between the epiglottis and posterior pharyngeal wall was too large in these manikins. [ 17 ] The resemblance of the manikin to human morphometrics is important. Thus, the type of manikin that is selected can be an important factor that can affect the performance of the device that is being evaluated or researched upon.…”