What are the primary challenges in conducting airway management research, and why are manikin studies sometimes preferred?

Airway management research faces several challenges, including securing funding, obtaining ethical approval, patient screening, recruitment, and retention, particularly for clinical trials. The low incidence of critical outcomes like failed intubation or death, combined with ethical considerations when testing new interventions, also complicates matters. As a result, researchers sometimes explore alternative study designs, such as manikin studies.

Can you elaborate on the specific methodologies used in the systematic review of airway management research, as described in the text?

A systematic review used specific methods to analyze airway management research. It involved a broad electronic database search of MEDLINE, Embase, and Web of Science, adhering to PRISMA guidelines. Studies were assessed using the PICO approach. Data extraction was independently performed by all authors onto a standardized Microsoft Excel spreadsheet. Statistical analysis included descriptive statistical analysis using SPSS, Spearman's rank correlation coefficient (r) to assess correlations, and the Chi-square test to compare categorical variables.

What were the key findings of the systematic review regarding trends in airway management research, including the types of subjects and the geographical distribution of studies?

The systematic review identified a significant increase in the number of prospective airway management trials between 2006 and 2017. Most publications originated from India, the USA, Japan, and Korea. Human patients were the primary subjects (71.9%), followed by manikins (21.4%). The review found 77 different primary outcome categories, highlighting the diverse focuses in airway management research.

What specific ethical considerations arise when conducting clinical trials with human patients in airway management research, as opposed to using manikins or cadavers?

Clinical trials involving human patients present unique ethical considerations compared to manikin or cadaver studies. The systematic review revealed that 71.9% of studies involved human patients. Researchers must carefully balance the potential benefits of new interventions with the risks to patients, securing informed consent and ensuring patient safety. Ethical concerns also arise when investigating interventions for rare but critical events like failed intubation.

Based on the systematic review, what are some potential future directions for airway management research to improve patient safety and outcomes?

Future research in airway management could prioritize specific areas based on previous studies. This includes focusing on basic airway techniques, assessment methods, and educational strategies. Core outcome sets could be developed to standardize outcome reporting across trials. Balancing manikin studies with patient-centered research is also crucial to ensure that research efforts translate into improved patient safety and outcomes. The findings of systematic review can inform strategies for the future directions.

Illustration of a clear airway leading to a serene landscape.

Airway Management Research: Are We on the Right Path?

Lena Voss in Health & Wellness November 2025 • 4 min read.

"A Deep Dive into Trends, Ethics, and the Future of Airway Safety"

Airway management is pivotal in patient care, and improving its safety and efficacy is an ongoing quest. Recent discussions have highlighted ethical concerns, particularly regarding research on patients versus the use of manikins or cadavers. It's a complex field where the value of different study 'subjects' is often debated.

Setting up a clinical trial involving human participants is challenging, with hurdles such as securing funding, ethical approval, patient screening, recruitment, and retention. This has led to the exploration of alternative study designs, like manikin studies, to overcome these challenges. Moreover, clinical trials face additional barriers due to the relatively low incidence of clinically important outcomes (e.g., failed intubation or death) and ethical considerations when investigating new interventions.

To comprehensively understand the current state of airway management research, a systematic review was conducted. This review aimed to describe how these studies are conducted, quantify the types of subjects involved (patients, manikins, etc.), assess the reported outcomes, and map global trends in this critical area of medical research.

Understanding Airway Management Research: Key Methodologies and Trends

Illustration of a clear airway leading to a serene landscape.

A systematic bibliometric review was conducted, adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. A broad electronic database search of MEDLINE, Embase, and Web of Science was performed with the assistance of an information specialist. The search included medical subject headings, controlled vocabulary terms, text words, and their variants related to the primary question of interest.

To ensure contemporary relevance, the search was restricted to studies published between January 1, 2006, and December 31, 2017. Full-text published manuscripts were examined utilizing the Patient, Intervention, Comparator, Outcome (PICO) approach to assess eligibility. The population of interest included: human patients (≥ 18 years); manikins; simulation studies; volunteer studies; bench studies and technological studies. Studies of pediatric (< 18 years) or neonatal patients were excluded.

Study Design: Encompassed prospective studies, including observational patient studies, experimental patient studies (randomized or non-randomized clinical trials), and prospective non-clinical trials (e.g., manikin, bench, simulation).
Data Extraction: Data were independently extracted by all authors onto a standardized Microsoft Excel spreadsheet. Data included study characteristics, primary outcomes reported, patient baseline characteristics for clinical studies, airway ease/difficulty, and operator attributes.
Statistical Analysis: Descriptive statistical analysis was performed using SPSS® for Mac, version 24.0. Correlations were assessed using Spearman's rank correlation coefficient (r), and the Chi-square test was used to compare categorical variables.

The findings of this systematic review highlight several critical trends. There was a notable increase in the annual number of prospective airway management trials over the study period. Publications emerged most frequently from India, the USA, Japan, and Korea. A detailed analysis revealed that the subjects of investigation were primarily human patients (71.9%), followed by manikins (21.4%). The review identified 77 different primary outcome categories across all studies, illustrating the complexity and varied focus of airway management research.

The Future of Airway Management Research

By understanding what has been previously studied, these data can form the basis for future priority-setting exercises and core outcome set development. These findings could inform strategies for the future directions of airway management research, ensuring that efforts are focused on the most critical areas for improving patient safety and outcomes. The balance between manikin studies and patient-centered research is key, as is the focus on basic airway techniques, assessment, and education.