title: Suitability of a preserved human cadaver model for the simulation of facemask ventilation, direct laryngoscopy and tracheal intubation: a laboratory investigation.
abstract: BACKGROUND
  Using fresh or formalin-embalmed cadavers has not been generally accepted for the purposes of teaching airway management. We investigated whether cadavers 'preserved according Thiel's embalming method' (PATEM) are suitable for the simulation of facemask ventilation and tracheal intubation by direct laryngoscopy.
  
  
  METHODS
  This observational cluster sampling, controlled simulation study, included eight PATEM cadavers and eight manikins in two clusters. Twenty experienced anaesthetists were randomly assigned to execute 80 facemask ventilations and 80 tracheal intubations in both groups. The ease of facemask ventilation was the primary endpoint. The secondary endpoint was the composite outcomes of laryngoscopy and tracheal intubation.
  
  
  RESULTS
  The success rate at the first attempt at mask ventilation was 74% (59/80 attempts) on cadavers and 41% (33/80 attempts) on manikins (P<0.0001). Twenty one subjects received an oral airway in both groups and succeeded in facemask ventilation 20 times on cadavers and four times on manikins (P=0.004). Two-handed technique mask ventilation was required 24 times on manikins and once on cadavers (P=0.0016). In one attempt on a manikin the mask ventilation was impossible. Poor laryngeal view (Cormack-Lehane grade 3) occurred 14 times among cadavers (17.5%) and once in manikins (1.25%) (P=0.007), whereas difficulties in tracheal intubation were encountered 16 times in cadavers (20%) vs 17 times in manikins (21.25%) (P=0.84). In a subjective evaluation the participants preferred the cadaver model over the manikins (P<0.0001).
  
  
  CONCLUSIONS
  PATEM cadavers were better suited for facemask ventilation and provided a more realistic environment for laryngoscopy and tracheal intubation than the studied manikins.
authors: Department of Anaesthesia and Intensive Therapy, Péterfy Street Hospital and Trauma Centre, Budapest, Hungary.
authors: Z
authors: Z
authors: Szűcs
authors: Department of Anaesthesia and Intensive Therapy, University of Debrecen, Debrecen, Hungary.
authors: C J
authors: CJ
authors: László
authors: Department of Anatomy, Histology and Embryology, Semmelweis University, Budapest, Hungary.
authors: G
authors: G
authors: Baksa
authors: Department of Anaesthesia and Intensive Therapy, University of Debrecen, Debrecen, Hungary.
authors: I
authors: I
authors: László
authors: Department of Human Morphology and Developmental Biology, Clinical Anatomy Research Laboratory.
authors: M
authors: M
authors: Varga
authors: Department of Human Morphology and Developmental Biology, Clinical Anatomy Research Laboratory.
authors: A
authors: A
authors: Szuák
authors: Department of Human Morphology and Developmental Biology, Clinical Anatomy Research Laboratory.
authors: Á
authors: Á
authors: Nemeskéri
authors: Department of Anaesthesia and Intensive Therapy, University of Debrecen, Debrecen, Hungary tassonyie@freemail.hu.
authors: E
authors: E
authors: Tassonyi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D016000:Cluster Analysis; D004867:Equipment Design; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D007828:Laryngoscopy; D008297:Male; D008397:Masks
keywords: airway management; education, medical; patient simulation