Videolaryngoscopy to Teach Neonatal Intubation: A Randomized Trial

Abstract

BACKGROUND: Neonatal endotracheal intubation is a necessary skill. However, success rates among junior doctors have fallen to ,50%, largely owing to declining opportunities to intubate. Videolaryngoscopy allows instructor and trainee to share the view of the pharynx. We compared intubations guided by an instructor watching a videolaryngoscope screen with the traditional method where the instructor does not have this view.METHODS: A randomized, controlled trial at a tertiary neonatal center recruited newborns from February 2013 to May 2014. Eligible intubations were performed orally on infants without facial or airway anomalies, in the delivery room or neonatal intensive care, by doctors with ,6 months' tertiary neonatal experience. Intubations were randomized to having the videolaryngoscope screen visible to the instructor or covered (control). The primary outcome was first-attempt intubation success rate confirmed by colorimetric detection of expired carbon dioxide.RESULTS: Two hundred six first-attempt intubations were analyzed. Median (interquartile range) infant gestation was 29 (27 to 32) weeks, and weight was 1142 (816 to 1750) g. The success rate when the instructor was able to view the videolaryngoscope screen was 66% (69/104) compared with 41% (42/102) when the screen was covered (P , .001, OR 2.81, 95% CI 1.54 to 5.17). When premedication was used, the success rate in the intervention group was 72% (56/78) compared with 44% (35/79) in the control group (P , .001, OR 3.2, 95% CI 1.6 to 6.6).CONCLUSIONS: Intubation success rates of inexperienced neonatal trainees significantly improved when the instructor was able to share their view on a videolaryngoscope screen. WHAT'S KNOWN ON THIS SUBJECT:Endotracheal intubation is a mandatory skill for neonatal trainees. It is a difficult skill to acquire, and success rates of junior doctors are low and falling.WHAT THIS STUDY ADDS: Videolaryngoscopy allows the supervisor to share the intubator' s view of the airway and provide more informed guidance. Teaching intubation using a videolaryngoscope with the screen visible to the instructor results in significantly higher success rates for inexperienced doctors.

Improving neonatal intubation safety: A journey of a thousand miles

“…Simulation studies have reported improved intubation success rates using videolaryngoscopy [46,48]. Recently, two clinical trials have examined the benefits of videolaryngoscope use during neonatal intubation [49,50].…”

“…Each intubation attempt was randomized to either have the screen covered, or visible to a preceptor who could then use the image to coach during the procedure [49]. Thirtysix residents' intubated 168 neonates at a median corrected gestational age of 29 weeks and a median weight of just over 1,100 g. The first-attempt intubation success rate was higher when the screen was visible to the preceptor, compared to when it was covered (66% vs. 41%, p < 0.001).…”

What Do NICU Fellows Identify as Important for Achieving Competency in Neonatal Intubation?

“…Koele-Schmidt and Vasquez [20] demonstrated an improvement in the time to successful TI after exposure to a computer module or VL but reported VL as the better teaching modality. O’Shea et al [21] observed improved TI success rates among inexperienced trainees when the instructor was able to view the VL screen. The participants in our study noted a limited utility of VL in ELBW infants; however, other studies have successfully used VL in this patient population [22].…”

Achieving Procedural Competency during Neonatal Fellowship Training: Can Trainees Teach Us How to Teach?

“…Furthermore, the use of video laryngoscopy was identified as a beneficial educational tool. Several studies [8-10], including the present study, highlight video laryngoscopy as an educational innovation which is promising.…”