Teaching airway resuscitation to novices: a randomized controlled simulator mannequin study

Introduction

The sniffing position is widely promoted for teaching airway positioning prior to intubation attempts, but whether this analogy results in novices placing the head and neck appropriately has not been evaluated. An alternate analogy - win with the chin - or simple anatomic instructions may perform better.

Methods

Randomized controlled study comparing different instructions for enabling novices to adequately position a simulator mannequin's head and neck. Study volunteers included medical students and PGY1 residents in surgery and internal medicine. Subjects independently positioned a mannequin based upon their understanding of four randomly-assigned written instructions for: the sniffing position; the win with the chin analogy; anatomic instructions; and no instructions (control). Digital photographs following each instruction were analyzed by two airway experts for adequacy of overall positioning, and for the three components of airway positioning.

Results

There were 81 volunteers. The positioning was adequate most often (43.2%) following the win with the chin analogy as compared with the other instructions (37.0% anatomic instructions; 19.8% control; 14.8% sniffing position analogy). Positioning following the sniffing position instructions was not different from no instruction (P = 0.53). The win with the chin and anatomic instructions were better than no instructions (P = 0.002 and P = 0.023, respectively).

Conclusions

The win with the chin analogy resulted in adequate airway positioning significantly more often than the sniffing position or control, and maintained atlanto-occipital extension when compared with providing anatomic instructions. Overall, win with the chin was a superior teaching analogy and could replace the sniffing position analogy.