To simulate a patient in respiratory arrest, a Laerdal® Airway Management Trainer manikin (Laerdal Medical, Stavanger, Norway) was installed on a stretcher. The mannequin’s lungs were bypassed and directly connected to an ASL 5000® artificial lung (IngMar Medical, Ltd., Pittsburgh, PA, USA) to simulate an apnoeic adult patient with compliance of 70 mL.cmH2O− 1 and resistance of 3.5 cmH2O.L− 1.s. The mannequin was ventilated manually with an Ambu Spur II bag, which has a reservoir of 2600 mL (Ambu A/S Baltorpbakken 13, DK-2750 Ballerup).
Airway management trainer
Manufactured by Laerdal
Sourced in Norway, Germany
The Airway Management Trainer is a medical training device designed for practicing airway management techniques. It simulates a human airway, allowing learners to practice intubation, ventilation, and other airway management procedures.
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Lab products found in correlation
18 protocols using airway management trainer
1
Simulating Respiratory Arrest with Manikin
2
Airway Management Trainer Simulation
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This study was conducted using a ‘Laerdal Airway Management Trainer’ (Laerdal Medical AS, Stavanger, Norway). This simulator offers two possible positions for tube insertion to an adequate depth: tracheal or oesophageal. When the tube is placed in the trachea and the cuff is blocked with 10 mm of air, two freely suspended lungs inflate to simulate a ventilation attempt. When the tube is placed in the oesophagus, a stomach balloon is inflated.
3
Simulating Adult Respiratory Mechanics
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The trachea of an anatomically correctly shaped male manikin (Laerdal®-Airwaymanagement-Trainer, Laerdal Medical GmbH, Puchheim, Germany), was attached to a test lung with a volume of 2.5 L, simulating the functional residual capacity of an adult man. Caliber of nostrils and degree of mouth opening were determined by the dummy and could not be altered. Before each experiment, the test lung was preoxygenated with pure oxygen to an oxygen saturation of 97% using an anaesthesia machine (Draeger Primus®, Drägerwerk AG & Co. KGaA, Lübeck, Germany). Subsequently, the test lung was connected to a gas analyzer sampling system with a suction rate of 200 mL/min (Draeger Primus®, Drägerwerk AG & Co. KGaA, Lübeck, Germany), a rate that is comparable to the oxygen consumption of an adult during apnea [14 (link)]. The sample was taken from the base of the test lung. The oxygen sensor itself is based on an electrochemical principle (Galvanic cell) containing sodium hydroxide and lead.
4
Simulated Airway Management Training
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One Carrycure Isolator, bag valve mask (Ambu SPUR II Adult, Ambu A/S), airway manikin (Laerdal Airway Management Trainer, Laerdal Medical), 7-mm endotracheal tube with a stylet, direct laryngoscope with Mac 4 blade, and 10-cc syringe were used for this study. The manikin was placed on a flat surface, and its height was adjusted by each participant to their most comfortable position to simulate the height-adjustable nature of the stretcher. Each participant was provided with new personal protective equipment (surgical gowns, nitrile gloves, masks, surgical caps, and protective goggles) for each trial (Fig. 2 ).
5
Comparative Airway Training Protocols for Novice Bronchoscopists
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Before training, all participants underwent standard multimedia education regarding basic FOB skills and key points of bronchoscopic intubation. Thereafter, the control and intervention groups engaged in 60 minutes of training involving a traditional airway manikin with normal airways (Laerdal Airway Management Trainer, Laerdal Medical) or a 12-hole clock model (Fig. 1; ZL201921518855.8), respectively. In the control group, the participants were required to manipulate FOB (UE Medical Corp., outer diameter 5.8 mm) pass from the mouth to the carina. In the intervention group, the participants were required to manipulate FOB sequentially pass from the 1st to 12th hole. During training, 2 experienced anesthesiologists provided real-time guidance and direct feedback on performance. Within 60 minutes of training, at least of 20 attempts were required in the control group and 3 attempts in the intervention group. The participants could choose to continue practice according to their wishes until the time was up. For each attempt, the participants recorded the hands-on time of bronchoscopic practice by themselves with a timer. The total hands-on time of bronchoscopic practice was calculated by summing the times of all attempts for each participant.
6
Airway Management Strategies in Trauma
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Two airway management scenarios were defined. In “Scenario A”, full head reclination was allowed, but in “Scenario B”, the cervical spine was fully immobilized manually as recommended by the Advanced Trauma Life Support algorithm [12 (link)]. Each participant received 15 min of standardized training on each device and in each study setting. Optimization maneuvers, the use of stylets and an estimation of the Percent of Glottic Opening (POGO) score were also explained and practiced under the supervision of experienced investigators [13 (link)]. The importance and the mechanism of dental injury were also highlighted. Each endotracheal intubation was performed with a standard 7.5-mm internal diameter, cuffed, plastic endotracheal tube (Mallinckrodt®, Covidien, Dublin, Ireland). Demonstrations, training and evaluations were all performed on the Laerdal® Airway Management Trainer (Laerdal®, Stavanger, Norway) [2 (link), 10 (link), 11 (link), 14 (link)].
7
Pressure Distribution Mapping of Respiratory Masks
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We used a pressure distribution sensor (Tekscan F-Socket sensor array 9811, Tekscan Inc., South Boston, MA, USA) fixed to the inside of a mask (mask size: 175 mm × 95 mm). The range of the pressure distribution sensor used in this study was 25 psi. The mask was mounted on a dummy head, and the sensor array was connected to the interceptor VersaTek Cuff. A 2-Port VersaTek Hub was then connected between the interceptor VersaTek Cuff and the computer. The pressure distribution on the dummy head (Laerdal Airway Management Trainer, Laerdal Medical, Stavanger, Norway) was measured by the sensor array when the mask was used together with the SMTRB (Figure 4 ). The head circumference of the dummy head was about 60 cm. Each style of SMTRB was measured ten times, and the maximum pressure values of the sensor were recorded. We also measured the pressure on the dummy face without an SMTRB.
8
Manikin-Based Nasogastric Intubation Comparison
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A manikin airway simulator was used to mimic the high-risk population that most often requires nasogastric intubation. The Laerdal Airway Management Trainer (Laerdal Medical, Wappingers Falls, NY, USA) has transparent anatomical structures that facilitate correct performance of nasogastric or nasotracheal tube placement. Standard Macintosh-type laryngoscopy was used for direct laryngoscope nasogastric tube placement. The Pentax Airway Scope AWS-5100 (Pentax Corporation, Tokyo, Japan) was used for video-guided laryngoscope nasogastric tube placement. Nasogastric tube placement was done using a polyethylene Levin tube (Symphon Chemical, Inc., Taipei, Taiwan).
9
Gastric Tube Placement Simulation Study
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The Ethics committee of the medical association of Rhineland-Palatinate did not require a formal approval of the study. Thirty one professionals of the Department of Anesthesiology participated in this study, including fourteen nurses, ten residents and seven specialists. Each participant was given a hands-on demonstration for the placement of the orogastric tube with and without the gastric tube guide (Fig. 2 ). The participants had to use both methods in randomized order, randomization was performed using the Research Randomizer Software [7 ]. The simulation manikin (“Airway Management Trainer”, Laerdal Medical GmbH, Puchheim, Germany) and gastric tube (14 Fr “Salem Sump PVC Gastroduodenal Tube”, Covidien Deutschland GmbH, Neustadt/Donau, Germany) were the same for all participants and no further tools were allowed. We recorded the times required for successful gastric intubation and the number of attempts. Each complete removal of the tube from the manikin was counted as a new attempt. After the procedure the participant was asked to rate his or her overall experience with the tool ranging from 1 (best) to 6 (worst).![]()
Manikin with the gastric tube guide – (
10
Assessing Visual Acuity in Airway Simulation
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Data for this research was obtained using an adult airway simulation trainer (Airway Management Trainer, Laerdal Corporation, Stavanger, Norway). A Sloan Early Treatment Diabetic Retinopathy Study (EDTRS) near vision chart measuring approximately 30 mm by 40 mm was inserted into the larynx of the airway trainer in an approximately vertical plane immediately in front of the vocal cords following a similar approach to that used by Baker et al. [9 (link)] The distance, inside the airway, from the VA chart situated in front of the vocal cords to the airway trainer's top row of teeth was measured. A piece of string was then measured as the difference between 40 cm and the distance between the VA chart and the airway trainer's top row of teeth. This piece of string was attached to the airway trainer's top row of teeth. The airway trainer was placed on a non-adjustable table at a height of approximately 75 cm to 80 cm from the ground. The same standard bulb stainless steel laryngoscope (Welch Allyn MacIntosh 2.5 V Standard Laryngoscope Set, Welch Allyn Hillrom, Chicago, USA) was available to all participants for laryngoscopy. Participants were allowed to choose the blade size for laryngoscopy, but were not allowed to use any adjunctive airway maneuvers.
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