Residents learning neonatal endotracheal intubation (ETI) had higher success rates but longer duration to successful intubation with a videolaryngoscope (VL) rather than a classic laryngoscope, according to a new study.
“Clinical practice that has changed, restricted duty hours of trainees and the presence of other health professionals capable of performing endotracheal intubation have greatly decreased trainees opportunities to practice endotracheal intubation,” said Dr. Ahmed Moussa of the Centre Hospitalier Universitaire Sainte-Justine in Montreal, Canada.
“The VL is a laryngoscope which allows video assistance for the performer and the observer. It has shown great impact in adult and pediatric medicine,” he told Reuters Health by email.
Earlier studies have found success rates of neonatal ETI by residents ranging from 33 percent to 63 percent despite training programs requiring competency for graduation, Dr. Moussa and colleagues note in Pediatrics. But VL has been tied to better ETI success rates in studies using mannequins, they add.
The team conducted a randomized controlled trial to test the success rate of neonatal ETI by 37 junior pediatric residents using either a VL or a classic laryngoscope (CL).
Overall, the VL group had a higher success rate than the CL group (75.2 percent vs. 63.4 percent, p=0.03). The success rate with VL increased with each additional procedure from 69 percent to 91 percent with seven ETIs. By contrast, the initial success rate was 33 percent with CL, rising to 80 percent at the seventh ETI.
The median duration of a successful ETI in the VL group was 57 seconds compared to 45 seconds in the CL (p=0.008). There were no significant differences for lowest oxygen saturation or bradycardic events during ETI, but there were more events of mucosal trauma in the CL group.
In a second phase of the study, during which all residents used a CL, the success rate for ETI was 63 percent among residents who had been randomized to VL and 77 percent among those randomized to CL group.
“The VL allows trainees to increase their success rate and learn endotracheal intubation at a more rapid pace. It is a safe laryngoscope for patients,” Dr. Moussa said. “When trainees learned endotracheal intubation with the VL and then were asked to perform intubation with a regular laryngoscope, some of the acquired skill was transferred from the VL to the regular laryngoscope. It is urgent for training programs to develop and implement education strategies such as the VL to improve rate of competency achievement of endotracheal intubation by pediatrics’ trainees.”