Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 28 , ISSUE 7 ( July, 2024 ) > List of Articles


An Indigenous Suction-assisted Laryngoscopy and Airway Decontamination Simulation System

Rajender Kumar, Rakesh Kumar

Keywords : Airway, Simulator, Suctioning, Suction-assisted laryngoscopy and airway decontamination

Citation Information : Kumar R, Kumar R. An Indigenous Suction-assisted Laryngoscopy and Airway Decontamination Simulation System. Indian J Crit Care Med 2024; 28 (7):702-705.

DOI: 10.5005/jp-journals-10071-24760

License: CC BY-NC 4.0

Published Online: 29-06-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Background: Suction-assisted laryngoscopy and airway decontamination (SALAD) is a new modality and training manikins are quite costly. Few modifications have been described with their pluses and minuses. We describe a low-cost simulator that replicates fluid contamination of the airway at various flow rates and allows the practice of SALAD in vitro. Materials and methods: We modified a standard Laerdal airway management trainer with locally available equipment to simulate varying rates of continuous vomiting or hemorrhage into the airway during intubation. The effectiveness of our SALAD simulator was tested during an advanced airway workshop of the Airway Management Foundation (AMF). The workshop had a brief common presentation on the learning objective of the SALAD technique followed by a demonstration to small groups of 5–6 participants at one time with necessary instructions. This was followed by a hands-on practical learning session on the simulator. Results: One hundred and five learners used the simulator including 15 faculties and 90 participants (48 on ICU and 42 on ENT workstations). At the end of the session, the workshop faculty and participants were asked to rate their level of confidence in managing similar situations in real practice on a four-point Likert scale. All 15 faculty members and 70 out of 90 participants felt very confident in managing similar situations in real practice. Fifteen participants felt fairly confident and 5 felt slightly confident. Conclusion: In resource-limited settings, our low-cost SALAD simulator is a good educational tool for training airway managers in the skills of managing continuously and rapidly soiling airways.

PDF Share
  1. Root CW, Mitchell OJL, Brown R, Evers CB, Boyle J, Griffin C, et al. Suction assisted laryngoscopy and airway decontamination (SALAD): A technique for improved emergency airway management. Resusc Plus 2020;1–2:100005. DOI: 10.1016/j.resplu.2020.100005.
  2. Kristensen MS, McGuire B. Managing and securing the bleeding upper airway: A narrative review. Can J Anaesth 2020;67(1):128–140. DOI: 10.1007/s12630-019-01479-5.
  3. Takenaka I, Aoyama K. Prevention of aspiration of gastric contents during attempt in tracheal intubation in the semi-lateral and lateral positions. World J Emerg Med 2016;7(4):285–289. DOI: 10.5847/wjem.j.1920-8642.2016.04.008.
  4. Takenaka I, Aoyama K, Iwagaki T. Combining head-neck position and head-down tilt to prevent pulmonary aspiration of gastric contents during induction of anaesthesia: A volunteer and manikin study. Eur J Anaesthesiol 2012;29(8):380–385. DOI: 10.1097/EJA.0b013e328354a51a.
  5. Mort T. Emergency tracheal intubation: Complications associated with repeated laryngoscopic attempts. Anesth Analg 2004;99(2): 607–613. DOI: 10.1213/01.ANE.0000122825.04923.15.
  6. Fiore MP, Marmer SL, Steuerwald MT, Thompson RJ, Galgon RE. Three airway management techniques for airway decontamination in massive emesis: A manikin study. West J Emerg Med 2019;20(5): 784–790. DOI: 10.5811/westjem.2019.6.42222.
  7. DuCanto J, Serrano KD, Thompson RJ. Novel airway training tool that simulates vomiting: Suction-assisted laryngoscopy assisted decontamination (SALAD) system. West J Emerg Med 2017;18(1): 117–120. DOI: 10.5811/westjem.2016.9.30891.
  8. Lorello GR, Cook DA, Johnson RL, Brydges R. Simulation-based training in anaesthesiology: A systematic review and meta-analysis. Br J Anaesth 2014;112(2):231–245. DOI: 10.1093/bja/aet414.
  9. Su Y, Zeng Y. Simulation based training versus non-simulation based training in anesthesiology: A meta-analysis of randomized controlled trials. Heliyon 2023;9(8):e18249. DOI: 10.1016/j.heliyon.2023.e18249.
  10. Chow Y. Recipe for SALAD (suction assisted laryngoscopy airway decontamination) simulation AKA “VomiQuin”. 2015. Available from:
  11. Ko S, Wong OF, Wong CHK, Ma HM, Lit CHA. A pilot study on using Suction-Assisted Laryngoscopy Airway Decontamination techniques to assist endotracheal intubation by GlideScope® in a manikin simulating massive hematemesis. Hong Kong Journal of Emergency Medicine 2021;28(5):305–313. DOI: 10.1177/1024907919884206.
  12. Sampson CS, Pauly JD, Horner JD. Low-cost portable suction-assisted laryngoscopy airway decontamination (SALAD) simulator for dynamic emesis. JETem 2019;4(2):1–7. DOI: 10.21980/J8362B.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.