International Consensus on Airway Management Procedures for Distance Simulation: A Delphi Study

Airway management is a core clinical competency, yet consistent and patient-safe hands-on training opportunities remain limited. Distance simulation, in which learners and facilitators are in different physical locations, may expand access to technical skills training. However, which airway management procedures are most suitable for this format remains unclear.

We conducted a three-round international Delphi study to identify and prioritize airway management procedures suitable for distance simulation. Fifty-four airway experts were invited, of whom 46 from 20 countries participated. In Round 1, experts proposed candidate procedures via free-text responses. In Round 2, procedures were prioritized using the Copenhagen Academy for Medical Education and Simulation Needs Assessment Formula, incorporating frequency, proportion of operators requiring competence, clinical impact, and feasibility for distance simulation. In Round 3, procedures achieving ≥ 70% agreement were retained.

Response rates were 85%, 89%, and 95% across the three rounds. The 464 free-text responses were consolidated into 54 procedures, of which 22 reached ≥ 70% consensus in the final round. Highly ranked procedures included direct laryngoscopic intubation, video laryngoscopic intubation, face mask ventilation, and laryngeal mask airway insertion. Emergency front-of-neck access with scalpel and bougie also achieved consensus. Rankings between Rounds 2 and 3 were strongly correlated (Spearman's ρ = 0.78).

This international Delphi study identified a prioritized set of airway management procedures suitable for distance simulation, including both high-frequency essential and low-frequency critical procedures. These findings support the development of standardized distance simulation curricula.

This Delphi process report presents an international group's expert views on process for how advanced airway management training in a simulator environment can be conducted where the instructor by necessity is in a remote location.