Brazilian Journal of Anesthesiology
Brazilian Journal of Anesthesiology
Original Investigation

Low-cost versus high-fidelity pediatric simulators for difficult airway management training: a randomized study in continuing medical education

Simuladores pediátricos de baixo custo versus alta fidelidade para treinamento de manejo de vias aéreas difíceis: um estudo randomizado em educação médica continuada

Corinne Lejus-Bourdeau, Florence Pousset, Cécile Magne, Olivier Bazin, Nicolas Grillot, Vincent Pichenot

Downloads: 0
Views: 792


High-fidelity (HF) pediatric patient simulators are expensive. This randomized study aimed to compare the quality and educational impact of a full-scale simulation workshop with an HF infant simulator (SimBaby™, Laerdal) or with a low-cost (LC) simulator composed of an inert infant manikin with SimBaby™ software that displays respiratory/hemodynamic parameters on a monitor for medical education in pediatric difficult airway management.

After written informed consent, anesthetists and emergency or ICU physicians participated in teams (4 to 6 participants) in a training session that included direct participation and observation of two difficult intubation scenarios. They were randomized into two groups (HF group, n = 65 and LC group, n = 63). They filled out a simulation quality score (SQS, 0 to 50), self-evaluated their anesthetists’ non-technical skills (ANTS) score (15 to 60), and an educational quality score (EQS, 0 to 60) immediately (T0, main criteria), as well as 3 (T3) and 6 (T6) months after the training session.

We enrolled 128 physicians. Direct participation SQS (39 ± 5 HF group versus 38 ± 5 LC group), observation SQS (41 ± 4 H F group versus 39 ± 5 LC group), ANTS scores (38 ± 4 HF group versus 39 ± 6 LC group), T0 SQS (44 ± 5 HF group versus 43 ± 6 LC group), T3 and T6 SQS were not different between groups.

Our low-cost simulator should be suggested as a less expensive alternative to an HF simulator for continuing medical education in pediatric difficult airway management.


High fidelity simulation training;  Medical education;  Infant;  Pediatric emergency medicine, anesthesia;  Airway management



Os simuladores de pacientes pediátricos de alta fidelidade (AF) são caros. Este estudo randomizado teve como objetivo comparar a qualidade e o impacto educacional de uma oficina de simulação em escala real com um simulador infantil AF (SimBaby™, Laerdal) ou com um simulador de baixo custo (BC) composto por um manequim infantil inerte com o software SimBaby™ que exibe parâmetros respiratórios/hemodinâmicos em um monitor para educação médica no manejo de via aérea difícil pediátrica.


Após consentimento informado por escrito, anestesistas e médicos de emergência ou UTI participaram em equipes (4 a 6 participantes) em uma sessão de treinamento que incluiu participação direta e observação de dois cenários difíceis de intubação. Eles foram randomizados em dois grupos (grupo AF, n = 65 e grupo BC, n = 63). Eles preencheram um escore de qualidade de simulação (SQS, 0 a 50), autoavaliaram o escore de habilidades não técnicas (ANTS) de seus anestesistas (15 a 60) e um escore de qualidade educacional (EQS, 0 a 60) imediatamente (T0 , critérios principais), bem como 3 (T3) e 6 (T6) meses após a sessão de treinamento.


Inscrevemos 128 médicos. SQS de participação direta (39 ± 5 grupo AF versus 38 ± 5 grupo BC), observação SQS (41 ± 4 grupo AF versus 39 ± 5 grupo BC), pontuações ANTS (38 ± 4 grupo HF versus 39 ± 6 grupo LC), T0 SQS (44 ± 5 grupo AF versus 43 ± 6 grupo BC), T3 e T6 SQS não foram diferentes entre os grupos.


Nosso simulador de baixo custo deve ser sugerido como uma alternativa menos dispendiosa em relação a um simulador de AF para educação médica continuada no manejo de via aérea difícil pediátrica.


Treinamento de simulação de alta fidelidade; Educação médica; Criança; Medicina de emergência pediátrica, anestesia; Manejo de vias aéreas


1. J.L. Apfelbaum, C.A. Hagberg, R.A. Caplan, et al. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway Anesthesiology., 118 (2013), pp. 251-270

2. C. Sims, B.S. von Ungern-Sternberg The normal and the challenging pediatric airway Paediatr Anaesth., 22 (2012), pp. 521-526

3. R. Patel, M. Lenczyk, R.S. Hannallah, et al. Age and the onset of desaturation in apnoeic children Can J Anaesth., 41 (1994), pp. 771-774

4. B.S. von Ungern-Sternberg, K. Boda, N.A. Chambers, et al. Risk assessment for respiratory complications in paediatric anaesthesia: a prospective cohort study Lancet., 376 (2010), pp. 773-783

5. J. Belanger, M. Kossick Methods of identifying and managing the difficult airway in the pediatric population AANA J., 83 (2015), pp. 35-41

6. V. Lassalle, J. Berton, G. Bouhours, et al. Medical paediatric simulation: a European survey Ann Fr Anesth Reanim., 28 (2009), pp. 628-633

7. J.J. Fehr, A. Honkanen, D.J. Murray Simulation in pediatric anesthesiology Paediatr Anaesth., 22 (2012), pp. 988-994

8. W.J. Eppich, M.M. Nypaver, P. Mahajan, et al. The role of high-fidelity simulation in training pediatric emergency medicine fellows in the United States and Canada Pediatr Emerg Care., 29 (2013), pp. 1-7

9. A.J. Donoghue, D.R. Durbin, F.M. Nadel, et al. Effect of high-fidelity simulation on Pediatric Advanced Life Support training in pediatric house staff: a randomized trial Pediatr Emerg Care., 25 (2009), pp. 139-144

10. M. Balki, S. Chakravarty, A. Salman, et al. Effectiveness of using high-fidelity simulation to teach the management of general anesthesia for cesarean delivery Can J Anaesth., 10 (2014), pp. 922-934

11. G. Fletcher, R. Flin, P. McGeorge, et al. Anaesthetists’ Non-Technical Skills (ANTS): evaluation of a behavioural marker system B J Anaesth., 90 (2003), pp. 580-588

12. K.H.K. Lee, H. Grantham, R. Boyd Comparison of high- and low-fidelity mannequins for clinical performance assessment Emerg Med Australas EMA., 20 (2008), pp. 508-514

13. Z. Friedman, N. Siddiqui, R. Katznelson, et al. Clinical impact of epidural anesthesia simulation on short- and long-term learning curve: High- versus low-fidelity model training Reg Anesth Pain Med., 34 (2009), pp. 229-232

14. E. Finan, Z. Bismilla, H.E. Whyte, et al. High-fidelity simulator technology may not be superior to traditional low-fidelity equipment for neonatal resuscitation training J Perinatol., 32 (2012), pp. 287-292

15. G. Norman, K. Dore, L. Grierson The minimal relationship between simulation fidelity and transfer of learning Med Educ., 46 (2012), pp. 636-647

16. S.N. Sudikoff, F.L. Overly, M.J. Shapiro High-fidelity medical simulation as a technique to improve pediatric residents’ emergency airway management and teamwork: a pilot study Pediatr Emerg Care., 25 (2009), pp. 651-656

17. M.A. Seropian, K. Brown, J.S. Gavilanes, et al. Simulation: not just a manikin J Nurs Educ., 43 (2004), pp. 164-169

18. A.L. Garden, D.M. Le Fevre, H.L. Waddington, et al. Debriefing after simulation-based non-technical skill training in healthcare: a systematic review of effective practice Anaesth Intensive Care., 43 (2015), pp. 300-308

19. S. Lapkin, T. Levett-Jones A cost-utility analysis of medium vs. high-fidelity human patient simulation manikins in nursing education J Clin Nurs., 20 (2011), pp. 3543-3552

20. C.C. Kennedy, E.K. Cannon, D.O. Warner, et al. Advanced Airway Management Simulation Training in Medical Education: A Systematic Review and Meta-Analysis Crit Care Med., 42 (2014), pp. 169-178

21. G.C.L. Fletcher, P. McGeorge, R.H. Flin, et al. The role of non-technical skills in anaesthesia: a review of current literature Br J Anaesth., 88 (2002), pp. 418-429

22. R. Flin, R. Patey, R. Glavin, et al. Anaesthetists’ non-technical skills Br J Anaesth., 105 (2010), pp. 38-44

23. R. Brydges, H. Carnahan, D. Rose, et al. Coordinating progressive levels of simulation fidelity to maximize educational benefit Acad Med., 85 (2010), pp. 806-812

24. K.K. Smith, D. Gilcreast, K. Pierce Evaluation of staff’s retention of ACLS and BLS skills Resuscitation., 78 (2008), pp. 59-65

25. B.M. Lo, A.S. Devine, D.P. Evans, et al. Comparison of traditional versus high-fidelity simulation in the retention of ACLS knowledge Resuscitation., 82 (2011), pp. 1440-1443

Submitted date:

Accepted date:

60cb67eaa9539565ec491513 rba Articles
Links & Downloads

Braz J Anesthesiol

Share this page
Page Sections