Video Laryngoscopy vs. Direct Laryngoscopy in Teaching Neonatal Endotracheal Intubation: A Simulation-Based Study

Abstract

BackgroundNeonatal endotracheal intubation is a life-saving procedural skill where best practices have been developed from expert opinion. Few empirical studies have examined how this skill should be taught.ObjectiveTo determine whether a video laryngoscope (VL) assisted intubation training curriculum compared to a traditional direct laryngoscope (DL) assisted curriculum improves neonatal intubation performance of novice intubators in a simulated setting.MethodsA randomized trial of novice intubators was conducted at the University of Texas-Houston from 6/2013–8/2013. Eligible candidates were randomly assigned to control group (DL curriculum) or intervention group (VL curriculum). Those in the intervention group received instruction with VL videos and practice with Storz C-MAC® VL (Karl Storz, Tuttlingen, Germany) in addition to a traditional curriculum. Intubation performance was evaluated in a simulated setting using a SimNewB® (Laerdal, NY, USA) manikin and traditional intubation equipment. The number of intubation attempts, outcome of each attempt, and time to successful intubation were recorded. The data was analyzed using Fisher's exact test and logistic regression where appropriate.ResultsOne hundred twenty-three trainees were enrolled, 62 (50%) in DL group and 61 (50%) in the VL group. Intubation success on first attempt was achieved by 69% (43/62) of the DL group vs. 61% (37/61) of the VL group, P=0.35. Time to successful intubation was 25 sec (interquartile range (IQR) 18, 32) in the DL group and 26.5 sec (IQR 20, 43) in the VL group, P=0.27. Those in the VL group were more likely to need more than two attempts to achieve intubation success, OR=3.09 (95% CI 1.03–9.28).ConclusionsIn a simulated setting, teaching with a VL curriculum did not improve intubation performance compared to teaching with DL. Further studies are needed to determine if VL-based teaching has an impact on clinical intubation performance.

Effectiveness of Self-Directed Small-Group-Learning Against Self-Directed Individual-Learning Using Self-Instructional-Video in Performing Critical Emergency Procedures Among Medical Students in Malaysia: A Single-Blinded Randomized Controlled Study

“…Teaching and learning of clinical procedures have always posed a challenge to medical schools and students due to several factors, such as lack of well-trained lecturers, limited student-lecturer contact time, fixed schedules, cost of hiring competent trainers and other logistic considerations ( Saiboon et al, 2014 ). It was found that skill teaching in medical schools was inadequate and the clinical or procedural skill experience among medical undergraduates was below expectations ( Offiah et al, 2019 ;Promes et al, 2009 ). Hence, physician educators should design clinical skill content and incorporate effective pedagogical approaches in order to improve the quality of education, and learner outcomes.…”

Examining Variations in Surfactant Administration (ENVISION): A Neonatology Insights Pilot Project

“…Supporting clinical evidence is limited and often decisions are made at HCP discretion based off historical practice, perceived surfactant distribution and tolerability. Video laryngoscopy provides the HCP with a shared airway view when intubating, but results are inconsistent for rates of intubation success during training for neonatal trainees and inexperienced HCPs [ 17 , 18 , 19 ]. Insufficient clinical evidence exists to compare video laryngoscopy to direct laryngoscopy for intubation success [ 20 ].…”

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

“…Even though many studies have compared the teaching effects of the 2 laryngoscopies, [5–8] no studies have reported whether there is an interaction between DL and VL as teaching tools, that is, whether using DL or VL first could enhance the teaching quality of ETI. Therefore, we examined the influence of the order of teaching ETI through DL and VL on learning by measuring the intubation time and learning curve of trainees, in order to explore ways to improve ETI performance.…”

“…The failure of the VL-first group to improve suggests that using VL as the initial tool for ETI does not lead to a higher ETI success rate. Nair et al [5] showed that in a simulation setting, teaching with VL did not improve learning compared with DL, and that using VL would likely result in the need for more than 2 intubation attempts.…”

“…In an attempt to improve the quality of trainee education and patient safety, using video laryngoscopy (VL) has been suggested as a teaching tool for ETI. [5–8] VL, which functions similarly to DL, enables the instructor to guide the trainee via a video monitor, avoiding the drawbacks of DL teaching and directly seeing what the trainee is actually seeing. [9]…”