Anesthesiology:
doi: 10.1097/ALN.0b013e318276c452
Correspondence

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Schebesta, Karl M.D.*; Kimberger, Oliver M.D.

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We commend Dr. Jelačić et al. for their efforts to add further evidence to the ongoing debate of airway research based on manikins by using our radiographic technique. In particular, the evaluation of the so-called airway task trainers or low-fidelity manikins might help to develop better training options for one of the most crucial skills in anesthesia and acute care—airway management.
There is a vast multitude of airway training manikins available, including the AirSim Bronchi (Trucorp, Belfast, Northern Ireland), the Airway Management Trainer (Laerdal Medical, Stavanger, Norway), and Ambu M MegaCode Trainer W (Ambu A/S®, Ballerup, Denmark). Only some of them have been evaluated in different benchmark trials or by means of radiographic techniques because of their general availability.1–4 Obviously, we were also only able to test an unavoidably arbitrary selection of commonly used simulators.
We fully agree with Dr. Jelačić et al. although radiographic evidence indicates that none of the evaluated manikins perfectly reflect the upper airway anatomy of actual patients (some better, some worse), other factors such as tissue elasticity and compressibility are equally important when it comes to judging how realistic a manikin can simulate an actual patient. The latter factors may be an explanation for the fact, that even though, for example, the AirSim and Airway Management Trainer significantly differ in radiographic measures, they are equal performance wise when compared with human cadavers.5
Finally, we firmly believe that there is a significant impact of the choice of a manikin on the performance and outcome in airway management training; however, subsequent investigations are necessary to elucidate the relevance of these choices on the application and transfer of simulator training in actual patient care.
Karl Schebesta, M.D.,* Oliver Kimberger, M.D.
*Medical University of Vienna, Vienna, Austria. karl.schebesta@meduniwien.ac.at
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References

1. Schebesta K, Hüpfl M, Rössler B, Ringl H, Müller MP, Kimberger O. Degrees of reality: Airway anatomy of high-fidelity human patient simulators and airway trainers. ANESTHESIOLOGY. 2012;116:1204–9

2. Cook TM, Green C, McGrath J, Srivastava R. Evaluation of four airway training manikins as patient simulators for the insertion of single use laryngeal mask airways. Anaesthesia. 2007;62:713–8

3. Jordan GM, Silsby J, Bayley G, Cook TM. Difficult Airway Society: Evaluation of four manikins as simulators for teaching airway management procedures specified in the Difficult Airway Society guidelines, and other advanced airway skills. Anaesthesia. 2007;62:708–12

4. Jackson KM, Cook TM. Evaluation of four airway training manikins as patient simulators for the insertion of eight types of supraglottic airway devices. Anaesthesia. 2007;62:388–93

5. Yang JH, Kim YM, Chung HS, Cho J, Lee HM, Kang GH, Kim EC, Lim T, Cho YS. Comparison of four manikins and fresh frozen cadaver models for direct laryngoscopic orotracheal intubation training. Emerg Med J. 2010;27:13–6

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