title: A radiographic comparison of human airway anatomy and airway manikins--Implications for manikin-based testing of artificial airways.
abstract: OBJECTIVE
  The aim of this prospective, single-center, observational study was to investigate the accuracy of modeling and reproduction of human anatomical dimensions in manikins by comparing radiographic upper airway measurements of 13 different models with humans.
  
  
  METHODS
  13 commonly used airway manikins (male or female anatomy based) and 47 controls (adult humans, 37 male, 10 female) were investigated using a mediosagittal and axial cervical spine CT scan. For anatomical comparison six human upper airway target structures, the following were measured: Oblique diameter of the tongue through the center, horizontal distance between the center point of the tongue and the posterior pharyngeal wall, horizontal distance between the vallecula and the posterior pharyngeal wall, distance of the upper oesophageal orifice length of epiglottis distance at the narrowest part of the trachea. Furthermore, the cross-section of the trachea in axial view and the cross-section of the upper oesophageal orifice in the same section was calculated. All measurements were compared gender specific, if the gender was non-specified with the whole sample.
  
  
  RESULTS
  None of the included 13 different airway manikins matched anatomy in human controls (n = 47) in all of the six measurements. The Laerdal Airway Management Trainer, however, replicated human airway anatomy at least satisfactorily.
  
  
  CONCLUSIONS
  This investigation showed that all of the examined manikins did not replicate human anatomy. Manikins should therefore be selected cautiously, depending on the type of airway securing procedure. Their widespread use as a replacement for in vivo trials in the field of airway management needs to be reconsidered.
authors.affiliation: Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt a. Main, Germany.
authors.forename: Richard
authors.initials: R
authors.lastname: Schalk
authors.affiliation: Department of Radiology, University Hospital Frankfurt, Frankfurt a. Main, Germany.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Eichler
authors.affiliation: Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt a. Main, Germany; Medical Campus University of Oldenburg, European Medical School, Department of Anaesthesiology and Intensive Care Medicine, Evangelisches Krankenhaus, Oldenburg, Germany.
authors.forename: Martin N
authors.initials: MN
authors.lastname: Bergold
authors.affiliation: Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt a. Main, Germany.
authors.forename: Christian F
authors.initials: CF
authors.lastname: Weber
authors.affiliation: Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt a. Main, Germany.
authors.forename: Kai
authors.initials: K
authors.lastname: Zacharowski
authors.affiliation: Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt a. Main, Germany; Department of Anaesthesia, Main-Kinzig-Hospitals, Gelnhausen, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Meininger
authors.affiliation: Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt a. Main, Germany; Medical Campus University of Oldenburg, European Medical School, Department of Anaesthesiology and Intensive Care Medicine, Evangelisches Krankenhaus, Oldenburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Byhahn
authors.affiliation: Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt a. Main, Germany. Electronic address: haitham.mutlak@kgu.de.
authors.forename: Haitham
authors.initials: H
authors.lastname: Mutlak
mesh_terms: D000328:Adult; D058109:Airway Management / Q000379:methods*; D000776:Anesthesiology / Q000193:education*; D002983:Clinical Competence; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008348:Manikins; D008953:Models, Anatomic; D016544:Patient Simulation; D011446:Prospective Studies; D011859:Radiography; D012137:Respiratory System / Q000000981:diagnostic imaging*
keywords: Airway management; Anatomic models; Intratracheal intubation; Manikin; Patient simulation