Comparison of a Novel Cadaver Model (Fix for Life) With the Formalin-Fixed Cadaver and Manikin Model for Suitability and Realism in Airway Management Training

Abstract

BACKGROUND:Manikins are widely used in airway management training; however, simulation of realism and interpatient variability remains a challenge. We investigated whether cadavers embalmed with the novel Fix for Life (F4L) embalmment method are a suitable and realistic model for teaching 3 basic airway skills: facemask ventilation, tracheal intubation, and laryngeal mask insertion compared to a manikin (SimMan 3G) and formalin-fixed cadavers.METHODS:Thirty anesthesiologists and experienced residents (“operators”) were instructed to perform the 3 airway techniques in 10 F4L, 10 formalin-fixed cadavers, and 1 manikin. The order of the model type was randomized per operator. Primary outcomes were the operators’ ranking of each model type as a teaching model (total rank), ranking of the model types per technique, and an operator’s average verbal rating score for suitability and realism of learning the technique on the model. Secondary outcomes were the percentages of successfully performed procedures per technique and per model (success rates in completing the respective airway maneuvers). For each of the airway techniques, the Friedman analysis of variance was used to compare the 3 models on mean operator ranking and mean verbal rating scores.RESULTS:Twenty-seven of 30 operators (90%) performed all airway techniques on all of the available models, whereas 3 operators performed the majority but not all of the airway maneuvers on all models for logistical reasons. The total number of attempts for each technique was 30 on the manikin, 292 in the F4L, and 282 on the formalin-fixed cadavers. The operators’ median total ranking of each model type as a teaching model was 1 for F4L, 2 for the manikin and, 3 for the formalin-fixed cadavers (P < .001). F4L was considered the best model for mask ventilation (P = .029) and had a higher mean verbal rating score for realism in laryngeal mask airway insertion (P = .043). The F4L and manikin did not differ significantly in other scores for suitability and realism. The formalin-fixed cadaver was ranked last and received lowest scores in all procedures (all P < .001). Success rates of the procedures were highest in the manikin.CONCLUSIONS:F4L cadavers were ranked highest for mask ventilation and were considered the most realistic model for training laryngeal mask insertion. Formalin-fixed cadavers are inappropriate for airway management training.

Suitability and realism of the novel Fix for Life cadaver model for videolaryngoscopy and fibreoptic tracheoscopy in airway management training

“…In our study, the participants rated the F4L cadaver model high with regard to suitability and realism, considering real patients as a reference. This finding is comparable to an earlier study in which the F4L cadaver model was found to be a realistic and suitable model for more basic airway manoeuvres [10]. For example, suitability and realism as a teaching model for mask ventilation were scored as 7.2 and 7.0 respectively, which is consistent with our current findings.…”

“…We are aware that not every hospital has the availability of a cadaver lab, but a university hospital as ours serves also as a regional training centre, and airway courses are given to an (inter-)national public where the cadaver lab can be integrated in the curriculum. However, currently used standard formaldehyde-based fixation techniques result in very rigid cadavers, which are not useful for airway management training [10,25]. While fresh frozen cadavers have the advantage that they are realistic after thawing, and are used in airway management training [26], continuing decomposition remains a major limitation.…”

“…After completion of the intubation procedures on all cadaver models with VLS, and subsequently with FOT, the participants were asked to give an overall verbal rating score (VRS) for each technique [ 7 , 10 , 12 ]. The participants were asked to rate the F4L cadaver model for suitability as a training model to learn VLS or FOT (“Considering real-life patients as a reference, how suitable is the F4L cadaver model as a teaching model to teach novices the use of VLS or FOT with regard to the technical aspects?”).…”

“…However, the method of conservation of these cadaver models is crucial, because the traditional embalmment with large amounts of formaldehyde causes the tissues to be rigid and makes airway management training rather unrealistic. Recently, a new cadaver model has been described, embalmed with 'Fix for Life' (F4L), which trainee and specialist airway practitioners have found to be realistic and suited for teaching basic airway management techniques, e.g., mask ventilation [10]. In the present study, we investigated the suitability and realism of the F4L cadaver model for the training of two advanced video airway techniques, i.e., VLS and FOT for tracheal intubation.…”

Workable Cadaveric Preservation for Developing Skills Training Models: A Review

“…The quest for ideal cadaver preservation for airway management simulation training concluded that fix for life (F4L) solution made up of a non-hazardous mixture of aldehydes and manikin cadavers were the most suitable method [54]. This review of merits and demerits of different cadaver preservation methods in usage for skill training model development impressed upon the impracticability of finding out the ultimate single cadaver fixation and preservative solution workable in all possible scenarios.…”