Development and assessment of a cyanosis simulator in a fetal manikin for extra-uterine life support innovation

Fidelity is a crucial factor affecting the efficacy of medical simulation training for clinicians. However, the inability of existing manikins to provide a realistic simulation of cyanosis undermines the ability to evaluate skill performance and clinical decision-making adequately. To address this gap, we developed and evaluated four color-changing mechanisms to realistically simulate cyanosis in newborn manikins. The four mechanisms included an electrochromic design using LEDs, a hydrochromic design using colored liquids, and two electromechanical designs using differently colored moving elements. We evaluated the effectiveness of these designs in simulating the correct cyanosis coloration using quantitative color measurements and comparing them with neonatal patient data. Additionally, we performed qualitative assessments with clinicians to evaluate the realism of the simulation. Our results demonstrate that a hydrochromic mechanism provides a realistic simulation of cyanosis coloration, as compared to neonatal patient data and through clinician assessment. Our study addresses the gap in realistic cyanosis simulation in newborn manikins, providing valuable insights for future iterations of medical simulation training for clinicians. These findings will guide the development of new manikins that can provide more accurate simulations, thereby enhancing training outcomes and improving patient safety.