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Crit Care Med. 2014 Jan;42(1):169-78. doi: 10.1097/CCM.0b013e31829a721f.

Advanced airway management simulation training in medical education: a systematic review and meta-analysis.

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1Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN. 2Department of Anesthesiology, Mayo Clinic, Rochester, MN. 3Division of General Internal Medicine, Mayo Clinic, Rochester, MN.



To perform a systematic review and meta-analysis of the literature on teaching airway management using technology-enhanced simulation.


We searched MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, Web of Science, and Scopus for eligible articles through May 11, 2011.


Observational or controlled trials instructing medical professionals in direct or fiberoptic intubation, surgical airway, and/or supraglottic airway using technology-enhanced simulation were included. Two reviewers determined eligibility.


Study quality, instructional design, and outcome data were abstracted independently and in duplicate.


Of 10,904 articles screened, 76 studies were included (n = 5,226 participants). We used random effects meta-analysis to pool results. In comparison with no intervention, simulation training was associated with improved outcomes for knowledge (standardized mean difference, 0.77 [95% CI, 0.19-1.35]; n = 7 studies) and skill (1.01 [0.68-1.34]; n = 28) but not for behavior (0.52 [-0.30 to 1.34]; n = 4) or patient outcomes (-0.12 [-0.41 to 0.16]; n = 4). In comparison with nonsimulation interventions, simulation training was associated with increased learner satisfaction (0.54 [0.37-0.71]; n = 2), improved skills (0.64 [0.12-1.16]; n = 5), and patient outcomes (0.86 [0.12-1.59]; n = 3) but not knowledge (0.29 [-0.28 to 0.86]; n = 4). We found few comparative effectiveness studies exploring how to optimize the use of simulation-based training, and these revealed inconsistent results. For example, animal models were found superior to manikins in one study (p = 0.004) using outcome of task speed but inferior in another study in terms of skill ratings (p = 0.02). Five studies comparing simulators of high versus low technical sophistication found no significant difference in skill outcomes (p > 0.31). Limitations of this review include heterogeneity (I2 > 50% for most analysis) and variation in quality among primary studies.


Simulation-based airway management curriculum is superior to no intervention and nonsimulation intervention for important education outcomes. Further research is required to fine-tune optimal curricular design.

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