The teaching order of using direct laryngoscopy first may improve the learning outcome of endotracheal incubation

Abstract

Background: Endotracheal intubation (ETI) is a life-saving procedure taught to medical students. We examined the influence of the order of teaching ETI through direct laryngoscopy (DL) and video laryngoscopy (VL) on learning by measuring the intubation time and learning curve of trainees, in order to explore ways to improve ETI performance. Methods: Twenty trainees were randomly divided into 2 groups. In the DL-first group, trainees used DL to perform ETI 10 times and then used VL 10 times, while the order was reversed in the VL-first group. Intubation time, number of intubation attempts, the Cormack-Lehane (CL) classification, and adverse events were recorded. The primary outcome was the cumulative summation (CUSUM). The CUSUM equation is defined as , where c t is the cumulative sum. Results: ETI was attempted on 400 patients. The difference in the mean times for the first 10 intubations between the 2 groups was not significant ( P > .05). Mean intubation time for second series in the DL-first group was significantly shorter than that of the first series ( P < .05), while there were no differences between the 2 series in the VL-first group ( P > .05). The mean intubation time in the second series of the DL-first group was shorter than for the first series of the VL-first group ( P < .05), while the mean intubation time of the first series by the DL-first group did not differ from the second series by the VL-first group ( P > .05). Eighteen attempts were required to achieve an 80% intubation success rate for the DL-first group, while more than 20 attempts were required for the trainees in the VL-first group. Conclusion: We consider that teaching trainees DL for tracheal intubation first. Clinical trial number: ChiCTR-OOR-16008364.

Endobronchial Intubation With the King Vision® and McGrath® Laryngoscopes in Simulated Easy and Difficult Airways by Novices (eKingMath)

“…Similar to previous studies, [18][19][20][21] the CUSUM analysis curve was constructed using standard type 1 error (α), standard type II error (β), the percentage of acceptable failure (p0), and the percentage of unacceptable failure rate (p1). The authors replicated these previous studies by designating 20% as the acceptable failure rate and 40% as the unacceptable failure rate based on the observations of the successful endobronchial intubation trials in the pilot study.…”

“…Type I and Type II error probabilities were .1. [18][19][20][21] In addition to the standard CUSUM chart, the learning curves tailored for various difficulty levels posed by every individual were documented. Table 1 shows the conventions and variables for the CUSUM analysis.…”

Pediatric airway management education and training

“…Interestingly, however, in an adult study, trainees required fewer attempts to achieve competency with VL if they were taught DL first. The authors' conclusion was, therefore, that it is probably advantageous to teach DL skills first …”

The Anesthesiologist’s Role in Teaching Airway Management to Nonanesthesiologists

“…This finding, however, is not consistent between studies and may be affected by the device, environment, and operator factors [ [75] , [76] , [77] ]. Additionally, it also has been suggested that novice trainees may have more rapid acquisition of DL skills when VL is practiced first with video-assisted instruction [ 78 , 79 ], although, again, this is not a consistent observation [ 80 ].…”