Comparison of the Airway Anatomy between Infants and Three Pediatric Simulators: A Radiological Study on Premature Anne, Infant AM Trainer and Simbaby Manikins

Background: Training is required to achieve proficiency in airway management. Simulators are of utmost importance not only for the purpose of training novices, but also for evaluating newer airway devices and techniques. Growing evidence supports inadequate anatomic airway reproduction in adult and pediatric manikins. Methods: We conducted an observational study comparing 17 radiological anatomic airway measurements obtained via the computed tomography of three commercially available manikins with the same measurements obtained from a population of newborns/infant (range: 0–3 months) undergoing magnetic resonance imaging for diagnostic purposes. According to the reference (mean and standard deviation (SD) of the pediatric population), each manikin measurement was defined as adequate, partially adequate or inadequate (difference between means: ≤±1, 1.0–1.96 or >1.96 SD, respectively). The primary outcome was the number of measurements with an adequate reproduction of airways. Results: We included 27 pediatric patients (21 ± 19 days, 48% males, 46.6 ± 3.5 cm, 2.7 ± 0.5 Kg and 12.6 ± 2.9 kg/m2). All manikins had n = 11/17 measurements with inadequate airway anatomic reproduction. The three measurements with more adequate reproduction were the height of the soft palate, retropalatal airspace volume and tongue volume (adequate in two manikins, and partially adequate in the remaining one). Conclusions: In three manikins commonly used for training in pediatric airways, static dimensions do not seem anatomically correct in relation to those of pediatric patients. Such inaccuracies may introduce biases in airway device development as well as in training.