A Fix for Airway Management Training?:Realism and Suitability of the Fix for Life Cadaver Model

Abstract

The primary focus of this thesis was the novel Fix for Life (F4L) cadaver model and its possible role in airway management training. The following research questions were addressed: 1. Is the F4L cadaver model a suitable and realistic model for the training and teaching of different airway management techniques? 2. How suitable and realistic is the F4L cadaver model for the training of the identification of the correct anatomical spot to incise for a ‘surgical airway’ (cricothyroidotomy), i.e., the identification of the cricothyroid membrane via palpation and ultrasonography? 3. What is the effectiveness of video-assisted fibreoptic intubation versus videolaryngoscopy in an established difficult airway F4L cadaver model? The F4L cadaver models were compared to formalin-fixed cadaver models and a manikin for suitability and realism for the teaching of 3 basic airway skills: facemask ventilation, tracheal intubation via direct laryngoscopy, and laryngeal mask insertion. The F4L cadaver model was ranked best for facemask ventilation. In other rankings, the F4L cadaver model was not ranked significantly different in regard to the manikin. Both the F4L cadaver model and the manikin were ranked significantly higher than the formalin-fixed cadaver model. With the exception of the score for realism of laryngeal mask insertion, all verbal rating scores between the F4L cadaver model and the manikin were not significantly different. The formalin-fixed cadaver model received the lowest scores. We concluded that there is potential of the F4L cadaver model in airway management training, particularly for facemask ventilation. The F4L cadaver model was also assessed for two advanced airway techniques, namely tracheal intubation with videolaryngoscopy and flexible fibreoptic tracheoscopy. The results in verbal rating scores obtained in this study were very promising, as these were higher compared to the previous study, indicating that the F4L cadaver model could be more suitable for these advanced techniques. These results suggest that the F4L cadaver model could be regarded as a suitable and realistic training model for advanced airway management techniques. A following study describes the suitability and realism of the F4L cadaver model for the training of the identification of the cricothyroid membrane with palpation or ultrasonography. The F4L cadaver model received high verbal rating scores for both techniques, being 8 or higher. The rate of successful identification was significantly higher in the ultrasonography group, although the time needed to do so was longer. We conclude that the F4L cadaver model is realistic and suitable to train the identification of the cricothyroid membrane. The final study primarily compared the success rates of tracheal intubation with videolaryngoscopy versus video-assisted fibreoptic intubation in a difficult airway F4L cadaver model. The success of tracheal intubation was higher with the video-assisted fibreoptic intubation technique, probably due to the higher percentage of glottic opening. In conclusion, the F4L cadaver model was the focus of our different investigations into the possible realism and suitability for airway management training, and the comparison of two intubation techniques for the management of a difficult airway. Based on our studies, the following conclusions can be drawn: 1. The F4L cadaver model could be a suitable and realistic alternative model to the manikin for the training of basic airway maneuvers, in particular for facemask ventilation. 2. The F4L cadaver model is a suitable and realistic model for the teaching of advanced airway procedures, namely videolaryngoscopy and fibreoptic intubation. 3. The F4L cadaver model is a suitable and realistic model for the teaching of cricothyroid membrane identification via palpation and ultrasonography. 4. The higher percentage of glottic opening score obtained with the video-assisted fibreoptic intubation technique versus videolaryngoscopy, probably translates to a higher intubation success in a difficult airway