Background: Endotracheal intubation is a core skill for airway management. With regard to the expertise of endotracheal intubation among physicians using a rigid laryngoscope, the body movement, the head movement, and movement of the gaze during the intubation procedure vary for each physician. This study aimed to test the hypothesis that the duration of endotracheal intubation, head movement, and movement of gaze intra-procedurally differ between experts and novices and assessed these factors using both a motion capture system and eyetracking system in a medical simulation setting. Methods: After obtaining institutional approval, individuals who were either novices or experts at endotracheal intubation using Macintosh laryngoscopes were recruited. Body motion and gaze distribution during endotracheal intubation of a mannequin were recorded and analyzed using a motion capture system and eye-tracking system. The values obtained were compared between the novices and experts. Results: The endotracheal intubation time was significantly shorter in experts (21.6 ± 7.6 sec vs 30.4 ± 8.3 sec, p=0.002), and the range of vertical head movement was smaller in experts (13.1 ± 7.7 cm vs 39.2 ± 8.1 cm, p<0.001), with significantly different trajectory, than those in novices. The ratio of downward gazing was significantly higher in experts (99.6 [96.7-100]% vs 32.4[18.8-43.4]%, p<0.001), and that of proximal gazing was significantly higher in novices (78.1 [67.9-85.6]% vs 37.2 [6.4-82.1]%, p=0.011). Conclusion: Body movement and gaze dynamics during endotracheal intubation with rigid laryngoscope differed between novices and experts. This system is a potential and feasible tool for evaluating the practice of endotracheal intubation.
Background: Video analysis of body and gaze movements has recently become widespread, mainly in the field of engineering, however, few medical studies have used motion capture and eye-tracking systems. The aim of this study was to test the hypothesis that head movements and gaze distribution during tracheal intubation differ between practitioners who are expert at tracheal intubation and those who are novice at tracheal intubation as a secondary analysis of our previous study. Methods: Practitioners who were either novices or experts at tracheal intubation using Macintosh laryngoscopes were recruited. Head movement and gaze distribution during tracheal intubation into a mannequin were recorded using motion capture and eye-tracking systems and analyzed according to 3 phases: phase A (mouth opening), B (obtaining vocal cord view), and C (tracheal intubation). The values obtained were compared between novices and experts. Results: Intra-group comparison showed significant differences in the height of the head and forward-backward head tilt during tracheal intubation in the experts and novices, respectively. Inter-group comparison showed significant differences at each phase except for the height of the head at phase A
Background: Video laryngoscopy (VL) is an attractive airway management device; however, its userʼs motion during tracheal intubation (TI) has not been evaluated. Therefore, this study aimed to investigate the differences in head and eye movement during TI using VL, McGRATH ® , between experts and novices. Methods: Time for TI, head movements, and gaze distribution during TI in a mannequin with McGRATH ® were recorded using motion capture and eye-tracking systems. TI was divided into three phases: A) from mouth opening to laryngoscope insertion, B) from the insertion into the mouth to enable visualization of the vocal cords, and C) from holding a constant vocal cord view to the finish of intubation. Data were compared between the experts and novices according to the phases. Results: In the experts, total TI time was significantly shorter (17.5 vs. 20.5 sec, p<0.001), and the duration of Phases A and C were significantly shorter (A: 5.0 vs. 6.4 sec, p<0.001; C: 8.1 vs. 9.2 sec, p=0.031). The intra-group comparison showed the head height in both groups significantly decreased until the Phase B and significantly increased in Phase C. Inter-group comparison showed the head heights in the Phases B and C were significantly lower in the novices (B: 152.2 vs. 142.6 cm, p<0.001; C: 157.4 vs. 145.9 cm, p<0.001). The height differences between the occipital and temporal regions indicated both groups turned their faces down from Phase A to B and upward in Phase C. The extent of head tilting in each phase was significantly larger in the novices. Gaze analysis indicated that while the experts continued looking down and further throughout TI, the novices looked up during Phases B and C. Conclusion: Posture and gaze distribution during TI using McGRATH® were different between the novices and experts. These results should be considered in instructing and learning TI.
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