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Trainees success rates with intubation to suction meconium at birth
  1. Marie-Ève Robinson1,
  2. Ileana Diaz2,
  3. Nicholas James Barrowman1,3,
  4. Nicole Huneault-Purney2,
  5. Brigitte Lemyre4,
  6. Nicole Rouvinez-Bouali4
  1. 1Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
  2. 2Respiratory Therapy Department, Ottawa Hospital, Ottawa, Ontario, Canada
  3. 3Department of Pediatrics, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
  4. 4Department of Pediatrics, Division of Neonatology, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
  1. Correspondence to Dr Marie-Ève Robinson, Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, K1H 8L1, Ontario, Canada, ; mrobinson{at}cheo.on.ca

Abstract

Objectives To assess the success rate and main reasons for failure of intubation performed by medical trainees to suction meconium below the vocal cords in non-vigorous infants delivered at ≥36 week gestation.

Design We conducted a prospective cohort study involving 54 residents and nine neonatology fellows in a Canadian level 3 neonatal intensive care unit. Endotracheal intubation to suction meconium was performed using a videolaryngoscope, the video screen being covered during the procedure. All videos were reviewed by two experts blinded to the procedure and to the identity of the trainee.

Results Sixteen videos were available to review between July 2014 and March 2016. Intubation success rate assessed by the reviewers was 6%, compared with 21% as assessed by the trainees. The most common reasons for intubation failure were an improper view of the glottis (87%) and meconium or secretions obscuring the view (67%). 36 % of the time, the trainees identified different reasons for intubation failure than the reviewers.

Conclusion Success rate of neonatal intubation to suction meconium was much lower than the success rate reported on infants without meconium. Teaching should be geared towards the most common reasons for intubation failure, possibly using video-based teaching.

  • neonatology
  • resuscitation
  • meconium
  • videolaryngoscope

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Footnotes

  • Contributors MER took part in the following: conception of the study, acquisition, analysis and interpretation of the data, drafting of the manuscript, critical revision of the manuscript and final approval of the version published. ID participated in the following: acquisition of the data, reading of all the videos, critical revision of the manuscript and final approval of the version published. NHP participated in the following: acquisition of the data, critical revision of the manuscript and final approval of the version published. NJB participated in the following: design of the study, analysis and interpretation of the data, critical revision of the manuscript as well as final approval of the version published. BL participated in the following: conception of the study, interpretation of the data, critical revision of the manuscript and final approval of the version published. NRB took part in the following: conception of the study, acquisition and interpretation of data, reading of all the videos, critical revision of the manuscript and final approval of the version published. All authors are accountable for all aspects of the work.

  • Funding This work was supported by a resident research grant (number RS2014-04) from the Children’s Hospital of Eastern Ontario Research Institute.

  • Competing interests None declared.

  • Ethics approval Research Ethics Boards of the Ottawa Hospital General Campus, Research Ethics Board of the Children’s Hospital of Eastern Ontario.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional unpublished data from the study are available to other individuals than the authors.

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