Use of video laryngoscopy versus direct laryngoscopy as a teaching tool for neonatal intubation: A systematic review

Abstract

Introduction Endotracheal intubation and positive pressure ventilation following delivery are required in 32.9% of neonates <31 weeks gestational age and in 5.9% of older newborn babies [1]. Competency in intubation is important, yet opportunities for learners to develop this skill in the clinical environment are limited. Direct laryngoscopy (DL) provides a direct view of the airway during intubation. Unfortunately, visualization of the airway is only available to the primary operator, preventing supervising instructors from simultaneously viewing the airway and allowing them to provide real-time feedback to learners. Video laryngoscopy (VL) is a specialized clinical instrument that utilizes an indirect view of the airway that is digitally projected onto a screen via camera, which allows multiple simultaneous viewers to view the airway during intubation attempts and permits instructors to provide real-time feedback to learners accordingly. Objectives This systematic review explores whether VL-supported learning is superior to DL for the development of skill in neonatal intubation. Methods Systematic searches of MEDLINE, EMBASE, CINAHL and the Cochrane Library were conducted without language restrictions. Studies published between January 2011 and November 2021 were examined. Randomized controlled trials (RCTs) comparing the effectiveness of VL versus DL for supporting neonatal intubation learning were included. Rate of successful intubation was the primary outcome measure. Both authors independently extracted study data and conducted risk of bias assessment. Results Four RCTs met the inclusion criteria, with two incorporating crossover designs. Each examined the effectiveness of VL versus DL, with concurrent supervisor support, as a tool for learning neonatal intubation in medical residents. All studies reported significantly higher intubation success rates with VL. Conclusion VL and real-time supervisor feedback is a more effective tool for supporting the development of neonatal intubation skill, compared with DL. Future investigations should include learners from other professions whose scope of practice includes neonatal intubation (eg, respiratory therapists).

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

“…In light of the evident advantage of video laryngoscopy demonstrated by Rivas and colleagues ( 1 ), and others ( 10 , 11 , 13 ) under controlled non-emergent conditions, some practitioners may question the potential extension of these benefits beyond the operating room. Observational studies conducted outside the NICU setting, such as those including both neonates and older children in the pediatric intensive care unit (PICU) have reported benefits associated with the use of video laryngoscopy ( 14 ).…”

“…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 ).…”