Success rate and duration of orotracheal intubation of premature infants by healthcare providers with different levels of experience using a video laryngoscope as compared to direct laryngoscopy in a simulation-based setting

Abstract

BackgroundEndotracheal intubation of very low birth weight infants (VLBWI) is an essential procedure in NICUs, but intubation experience is often limited. Video laryngoscopy (VL) has been described as a tool to improve intubation skills, but studies in high-risk neonatal populations are limited.ObjectiveThe aim of this study was to investigate whether VL is a useful tool to support airway management in high-risk premature infants with inexperienced operators.MethodsIn this crossover study predominantly inexperienced participants were exposed in random sequence to VL and conventional direct laryngoscopy (DL) for endotracheal intubation of a VLBWI simulation manikin to measure total time, number of attempts, success rate on first attempt, view of the vocal cords and perceived subjective safety until successful intubation.ResultsIn our study group of 94 participants there was no significant difference in the total time (mean VL: 34 s (±24 s); DL: 37 s (±28 s), p = 0.246), while the number of intubation attempts using VL was significantly lower (mean VL: 1.22 (±0.53); DL: 1.37 (±0.60), p = 0.023). Success rate of VL during the first attempt was significantly higher (VL: 84%; DL 69%, p = 0.016), view of the vocal cords was significantly better and perceived subjective safety was increased using VL.ConclusionsOur study results suggest that with rather inexperienced operators, VL can be a useful tool to increase rate of successful endotracheal intubation of VLBWI and to improve their perceived safety during the procedure, which may have an impact on mortality and/or morbidity.

Factors that impact second attempt success for neonatal intubation following first attempt failure: a report from the National Emergency Airway Registry for Neonates

“…Change in laryngoscope type was rare and did not increase the chance of second attempt success. Several studies have suggested benefits to VL as a training tool for less experienced neonatal staff, although evidence regarding broader settings and experience levels is less clear 7 20–22. A Cochrane systematic review of VL use in neonates reported increased success for the first attempt at TI, but no overall reduction in the number of TI attempts, with modest sample sizes and moderate to very low quality evidence 23.…”

Video laryngoscopy as the standard of care for pediatric intubation—the time is now

“…Another often overlooked advantage of video laryngoscopy, not captured in a randomized trial involving experienced proceduralists like the one conducted by Rivas and colleagues ( 1 ), is its role in procedural training and coaching. By creating a real-time shared visual model between the proceduralist and other team members, video laryngoscopy has been associated with improved outcomes when used as a coaching device during intubation attempts by inexperienced operators ( 13 ), and during simulation ( 20 ). In fact, first-attempt intubation success rates among inexperienced trainees learning endotracheal intubation is significantly improved when an instructor provides real-time coaching while sharing the operator’s view on the video laryngoscope ( 21 ).…”