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  • Cadaver Vs Mannequin Airways - Yang

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    Cadaver Vs Mannequin Airways - Yang

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    "Deparment of Emereancy Madeine, Coline of Mee, The Cathe Usesstyof Ca, Som Sot Koon = Deparment of Erareney dene, Yoo User (olege of Medere, sraram ‘Sevaaree Hosp, Sen ‘South Koes: * Department of Eargency Mosina, Ea Genera Hostal, Sand, South area * Department oF Emergeney Mere, Han Uneraty Matic Ctr, ‘eroram Saued Heart Hoot, ul Sah Ker "Deparment of Ererency Made, Bundong CHA Hospi, Sangean, South oven: Deparimert o Eegeney Mesone, Henarg Univers Colage of Medora Sons, Sou Korea > Deparment of Enarency IMasnina, Sen Onn yang Universiy Bieber Has Buches, Sots Korea 1 Young Soon Cho, Daparsrane 0 Emergeey Medic, Soon Chun yang Urvrsy seen Hosp 1176, Jing dona Worreau, susieons yeongg-do $2020, Sth Kare chamungssang arate ecept 22 March 2008 nar Meg 201027 1218, 0.11 Original article Comparison of four manikins and fresh frozen cadaver models for direct laryngoscopic orotracheal intubation training JH Yang,’ Y-M Kim,’ HS Chung,? J Cho? H-M Lee,? G-H Kang,* E-C Kim,®T Lim,* Y $ Cho? ABSTRACT Objective: To compare the acoeptailty and preference between manikin models and fresh frozen cadaver [FFC) for direct eryngoscopic ortrachea! intubation taining ‘Methods: In this prospoctve cnssover til, partiipants in the away werkshap performed direct lyngoscopic rotracal intubation on four airway training manikns Airway Management Trainer (Ambu, St ues, UK), Arway Trainer (Laerdal, Metical, Sivanger, Norway), Aisin (Trucorp, Beliast, Norther Ireand) and “Bil 1" BN, Sula, Germany), and FFC, Parcinants were asked to ancess the following: resity of jaw mabliy, dficuty with mouth opening, realty of neck flexi, cfculty with intubetion, overall model realty and model preference fer ath model using 2 viual analogue scale [VAS) of 0 1D om, The VAS scores far each model were compared. Results: Fity-sbsaricinants were inclced inthe stud ‘The FEC had a highest VAS score for realty of jaw mobility, overall eat end preference of model. Trucorp manikin and Laerdal manikin followed cadaver. There ‘were no sionfcant statistical diferences betwoon Tiucorp manikn and Laerdal mani. In efiuly with mouth opening and difiuty with intubation, Trusorp manikin had the lawest VAS score Conclusion: The FEC is @ more reaistic and prefered ‘adel for direct lryngoscopic eotrachea intutaton tring. Thwcorp and Laerdal marikn can be used as alterative models. All doctors with acute care responsibilities are ‘expected co be competent in airwely management For emergency doctors to perform accurate and rapid tracheal intubation in critical situation, appropriate educstion and training are required.” ‘Manikins have been used generally as a tool to teach invasive procedures to medical personnel and students, Currently, there are multiple manikin ‘models suited for use in various training cechni- ques, such as airway management and psychoma- tor skills, but the downside of manikin modele is their fixed structural content and lack of realism. ‘The use of cadavers for medical students and resident procedural training has been cited as an effective educational model for the pest several yeacs?* To cur knowledge, the fresh frozen cadaver (FFC) has not been evaluated as a tool for Intubation taining. Compared with the traditional sdaver, FEC may provide a better model for procedural skills craining, as tissue planes are not Gistorted by che embalming process? We have ‘exalusted and compared four custently available zone os airway manikins with FEC to determine their adequacy and preference as simulators for intuba- tion skill taining METHODS ‘This was a prospective crossover study shat was undertaken in 56 participants on the emergency airway management courses hosted by the Korean Emergency Ainvay Management Society from April 2007 to September 2007. The courses included didectic lectures followed by sk sions using manikins and FEC, The various techniques were performed in ll ststions. Instuctions were provided by board.ceriied emergency doctor, This study was approved by the institutional seview board, and informed consent was obtained from each participant. Direct laryngoscopic orotracheal intubation technique was instructed in the lectute component of the course. Participants performed orotracheal intubation on foue away manikins and FEC, The corer in which the manikins were tested was randomised using computerisation, The four atr sway manilins used are shown in fg 1 and were a= follows: (1) Airway Management Trainer (Arab, Se Ives, UX), (2) Airway Trainer (Laerdal Mesical, Stavanger, Norway), (8) Asim (Trucorp, Belfast, Northern Ireland) and (4) “Bill 1” (VBM, Sule, (Germany) “These are referred toby their mans factutes (ie, Ambu, Leerdal, Trucorp and VBM), Recently deceased cadavers were obtained from the Catholic Institute for Applied Anatomy. The cadavers were not formalin fixed but wete arte rally flushed wich an isopropyl alcohol solution 20 preserve natural tisue turgor and prevent degrada tion, The cadaver remained frozen and was Elly thawed before the initiation of the course ‘Orotracheal intubstions were performed using the Macintosh no. 5 curved blade (Welch Allyn, Skaneateles Falls, New York, USA) and an endo tracheal tube with an internal diameter of 80 mm. The maximum time allowed for an intubation attempt was 20s, and single intubation attempt was allowed on each manikin and FFC. Correct placement of the tzacheal tube vias thereafter Confirmed by an instructor ‘Afver intubation, participants were immediately {questioned on demographics, previous experience in airway craining and actual expedence. They ‘were asked to score the following on visual analogue scale (VAS) of 0-10 em: reality of jawe mobility, dil wit mows coma eaiy of rece Hexebly, iffiuley with procedure, reality oF 8 foe Figure 1. Airway manikin madels used {or intubation taining 2) Airway Management Taine |Ambu),(b) Airway Trainer (Laer), (c} Asim (Trucop) and (d) Bill (VBM, ‘model and preference of model. The patticipants were blinded of each others scores. “The sample size was calculated according to the preference of model, A VAS difference of 1.3 was selected as the minimum linically value* We used the pilot study performed by 15, ypartcipants from previous course as our teference. Using the VAS SD of 2.0 for preference of model, we calculated that 2 somple size of 50 participants was sufficient to detect an effect, ‘value at a significance level of 0.05 (two-sided) with 80% power Nominal variables were expressed a5 frequency and percen~ tage. Continuous variables were expressed as mean and SD. The WAS. scores. for_each model. were compared with ANOVA. “Tulkey multiple comparisons test was used for past hoc analysis. Differences were considered significant where p=0.09. Statistical analysis was performed using SPSS V.130 for Windows. RESULTS ‘The participants consisted of 49 (76.8%) doctors and 18 (23.2%) murses. Of the 43 doctors, there were 11 board-certified emergency doctors (25.6%). Twenty (@5.7%) participants had fo airway management training experience, but che majority (24; 42.596) had one to three experiences in airway management training. Thiry-eight paticipants (679%) had previous oro: tracheal intubation experience with actual patients. ‘VAS scores were highest in FEC for reality of jaw mobility. In ‘with mouth opening, Taucorp manikin was prefessed lover the other chree manikins, and no statistical significance ‘was found compared with FFC. VAS scores were highest in FRC for reality of neck Hexibiliry, but these was no_ statistical difference in the Laerdal, Trucorp manikin end FEC. Laerdal and Trucorp manikin were favoured over VBM manikin. In diffulty with procedure, Trucorp manikin was easier chan any other model. In VAS scores of overall reality and preference ‘of model, statistical analysis showed that FEC was preferred lover manikins, laerdal and Trucorp manikin were favoured aver ‘Ambu-and VBM manikin (table 1). The results from the 86, articipants with actual ororracheal intubation experience were Sular (able 2) “The fist intubation was suecessful on four manikins and FEC in =65.7%-100% (table 8), On VBM manikin, the success rate for the first ateempt was significantly poorer. piscussion Tn this study, we attempted to compare ease of use, accept ability and model preference for direct laryngoscopic orotracheal {ntubation training between four airway manikins and FRC. In the--past,~intubation training was.-performed dectly-.on- patients, but this raised ethical and safety isues, so snimal of fadaver models were used instead. Nowadays, we have the privilege of taining with various manikin models, such a3 Simple task trainers and high-fdelicy human simulators’ ® Simple task trainers can provide psychomotor skill taining, but they lack the teality of the procedure. While bigh fidelity ‘human simulators also provide psychomotor and cognitive skill training, they also lack the reality for prychomotor sls training, Animal models are realistic for training, but the anatomical differences defer us from using them as training models. In addition, there are animal rights issues to be taken FEC is excellent model for psychomotor skill raining. They maintain the texture and realism of live humans. Therefore they are considered appropriate psychomotor training madels* ‘A previous study looking at the efficiency and realism for training of certain procedures (intravenous puncture, nasogss- ‘tric tube insertion and lumbar puncture) reported a favourable ‘outcome for cadaver model over manikin madels." Howeves, 0 intubation skill training (Qur study shows a favourable outcome for FEC over manikins in ceality of jaw mobility, reality of neck Hexbility ‘and overall reality of model. When comps ig the four ‘Bmay Med J 2010271318. dD 1136 2 ib | | | ‘Table 1 Visual analogue scale scores of the four mankins and fresh frzen cadaver (FEC) a ‘words)——_Taborp Reayotiew 45 (22) Sit) S82) nity t © » » Dewy wenmouh $324) SS (23) 82a) nia tt . € . Feay ofneck 47122) 62) BBS} ou if be 2 ab Ditcuty wih 5824) «= SO = «87D, procoare t > » 2 Reaiyofmeds] 4423) 58012) SIRS) Tt ° 5 5 Pence ofmedel 40°23) BAT] 8.12) tt © » i ‘Ws we posed os an 5D vem Fe r 39123) Tala) ~=n001 bo@s) as) <1 be ae iy 62m Dewy win mesh 6025) $312) 29,8) pering tr . » a Resty ofoeck —42(20) BBCI) BN) foaby t » . ab Diicaty wih = SBZO «48GB. /28) oosiue 1 be » . Rist ofmadel 3918) S(T] —50(24) ot : » be Patron olmedel 201) 62/4) 60/27) Tt e > . ‘ales we pes as en 0) “Sutetea seas: wee tse by nesaay ANOVA among Trop va 3ziaa) 73108) fan 2160) <0001 » 2 39023) 8200) 00a » 2 jogs eam, noo! . ab any 75228) -

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