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Rescuing the obese or burned airway: are conventional training manikins adequate? A simulation study
T E Howes1, C A Lobo2, F E Kelly2
1Department of Anaesthesia, Royal United Hospital, Combe Park, Bath BA1 3NG, UK drtimhowes@gmail.com.
Simulating obese patients with modified manikins improved anesthesiologist training for percutaneous tracheal access. This approach better prepares clinicians for challenging airway emergencies, reducing failure rates.
Area of Science:
- Medical simulation
- Anesthesiology
- Emergency medicine
Background:
- Percutaneous tracheal access is crucial in airway emergencies, with high failure rates.
- Obesity and neck pathology increase supraglottic airway management failure.
- Standard manikins may not adequately prepare anesthesiologists for complex cases.
Purpose of the Study:
- To evaluate anesthesiologists' performance in percutaneous tracheal access using modified manikins.
- To simulate challenging patient anatomies, including obesity and neck burns.
- To assess the effectiveness of modified manikins in improving training outcomes.
Main Methods:
- Modified a standard 'front of neck' manikin with belly pork to simulate obese and burned obese patients.
- An unmodified manikin represented a slim patient.
- Twenty consultant anesthesiologists performed percutaneous tracheal access on each manikin in a 'can't intubate, can't ventilate' scenario.
Main Results:
- Success rates varied: 100% for 'slim', 60% for 'morbidly obese', and 77% for 'burned obese' manikins.
- Time to effective breath was longer for the 'morbidly obese' manikin, with 20% requiring over 720 s.
- Modified manikins demonstrated greater technical difficulty, aligning with real-life challenges.
Conclusions:
- Simulating obese patients with modified manikins significantly increases technical difficulty.
- Training with modified manikins better prepares anesthesiologists for challenging percutaneous tracheal access scenarios.
- Development of commercial manikins simulating complex anatomies is recommended.
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