A Prospective Observational Crossover Study Comparing Intubation by Pediatric Residents Using Video Laryngoscopy and Direct Laryngoscopy on a Pierre Robin Simulation Manikin

Abstract

Introduction: Video laryngoscopy (VL) has been proposed to increase the likelihood of successful intubation in patients with predicted difficult airways such as those with Pierre Robin sequence (PRS). Prior studies have focused on the performance of anesthesiologists, who are generally considered airway experts. Our primary aim was to investigate the success rate of intubation using VL compared with direct laryngoscopy (DL) when attempted by pediatric residents on a PRS model. Methods:Participants were administered a 5-minute refresher video on 2 VL techniques (CMAC, conventional geometry VL, and McGrath, unconventional geometry VL) and DL. The participants were asked to intubate the AirSim PRS infant manikin. The order of VL and DL use was randomly selected. All intubations were video recorded, and the recordings were analyzed by 3 anesthesiologists blinded to the participant's identity and previous experience.Results: Seventeen of 23 residents succeeded in intubating the PRS model using DL. Only 9 residents succeeded in intubating the PRS model using VL (conventional or unconventional geometry). Intubation success rate was higher when comparing DL with VL (P = 0.04) and similar when comparing VL devices (P = 0.69).Discussion: Contrary to expectation, the intubation success rate was lower using VL than with DL among pediatric residents. This should be considered when designing residency training and in real-life resuscitation.

Tracheal intubation in patients with Pierre Robin sequence: development, application, and clinical value based on a 3-dimensional printed simulator

“…In addition, Park et al (2021) reported a case of using a 3D printed model to simulate TI before anaesthesia to improve the quality of airway management. Meanwhile, Shaylor et al (2023) carried out a randomized trial of the video laryngoscope to the flexible fiberoptic bronchoscope in a Pierre Robin manikin, the first-attempt success rates were 88.3% and 85.0%, respectively. In this study, the trained anaesthesiologists made significant improvements in simulation performance after training, and the training time on the training simulator was gradually reduced.…”

“…This technology has been widely applied in orthopaedics, neurosurgery and orofacial surgery, but its use in anaesthesia has not yet been full-scale ( Sinn et al, 2006 ; Suomalainen et al, 2015 ; Mulford et al, 2016 ). Previous studies have shown that the use of 3D printing to create a patient’s airway model can help anaesthesiologists more fully understand the morphology of the trachea, choose the appropriate catheter, and determine a more secure intubation approach in advance ( Fiadjoe et al, 2015 ; Park et al, 2021 ; Shaylor et al, 2023 ). Furthermore, in real-world procedures, the intubation time has been shortened, the success rate of intubation has been increased, and complications caused by repeated intubation have mainly been avoided ( Han et al, 2016 ).…”