Development of an Obese Airway Model for Front of Neck Access Training and Research.

Background: Airway management in obese adults can be challenging. Obesity causes both anatomical and physiological changes that make a difficult airway more likely and rescue techniques more likely to fail. The final approach to "can't intubate, can't oxygenate" in airway management is acquiring front-of-neck access (FONA) to facilitate oxygenation. Although incredibly rare, it is essential that the quickest and most efficient technique is utilized. Therefore, FONA needs to be taught and performed to the highest standards to maximize the chances of success. However, there is a distinct lack of obese models available for FONA training. Standard training models do not replicate obesity, and obese model designs described in the literature are often bespoke to the authors' facility. Objective of the Innovation: To create a model that replicates the obese airway as much as possible, both in size and girth of the neck, thickness of the anterior neck skin folds, tactile feel of the subcutaneous tissue, and the lack of anatomical landmarks. For education and training purposes it should be cheap and easily produced. For research purposes it should be reproducible with little variation between subsequent models using the same materials. Development Process and Implementation: We trialed several models, including animal and synthetic products, culminating in a model involving a commercially available task trainer, 3D printed larynx for increased anatomical accuracy, ballistics gel to reproduce subcutaneous adipose tissue and the proprietary skin supplied with the commercial model. A pilot phase involved use of the model in various educational forums, with fine tuning of the model as issues were identified. Conclusion: The final model adequately reproduces the obese airway while being cheap, easily reproducible, standardized for obese airway FONA research, and can be produced en masse for large educational forums.