Practicing Mechanics of Intubation

Cadavers often a unique opportunity for airway practitioners to interact and visualize human tissue without the clinical risks associated with practicing on live patients.  Airway management and intubation in live patients cannot be done repetitively just to compare, test, or practice different techniques.  This is not a problem in cadavers.

Practicing laryngoscopy and intubation on the newly deceased patient was an acceptable training method in the past, but is not currently done without family consent in most US institutions.   Few practitioners are eager to pursue this permission in the setting of a recent death, and many families are not willing to consent.  Consequently, this type of airway procedural practice is no longer commonplace.

Rigor mortis can prevent laryngoscope insertion or practicing any other oral airway technique.  It typically occurs about three hours after death, and depending ambient temperature, may last up to 72 hours.  Conversely, formalin fixed (embalmed) cadavers have a leather like rigidity that inhibits mouth opening and only permits surgical airways.  For laryngoscopy and other procedural training cadavers that work well are either fresh frozen (and thawed) or specially prepared (venous drained and infused with alcohol solution) to retard putrification and tissue degradation.

Chevalier Jackson, a pioneer of laryngoscopy and the specialty of laryngology, recommended cadaver training as a way to “educate your eye and your fingers.” In his 1922 text on Bronchoscopy and Esophagoscopy, he writes: “The fundamental principles of peroral endoscopy are best taught on a cadaver” and “in no other manner can the landmarks and endoscopic anatomy be studied so thoroughly and practically.”

Click here to see a PDF of Chevalier Jackson’s 1922 text (cadaver training is mentioned on page 120)

There are very limited opportunities for procedural training on cadavers in the United States or anywhere else in the world. Starting in 2001 Dr. Richard Levitan created the only regularly scheduled and repeating airway procedure course using a large number of specially prepared cadavers.  It is offered monthly (except January) in Baltimore, and involves 18 cadavers per course for 18 participants.  The focus of the course is on laryngeal and airway anatomy combined with a practical approach toward emergency airway management.  In addition to intensive laryngoscopy, the course includes hands-on training with the full gamut of intubation and ventilation techniques including optical stylets, video laryngoscopes, optical laryngoscopes, supraglottic airways, and surgical airways.

Click here for more information on this unique airway procedure course