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Analysis of unsuccessful intubations in neonates using videolaryngoscopy recordings
  1. Joyce E O’Shea1,2,
  2. Prakash Loganathan3,
  3. Marta Thio2,4,5,6,
  4. C Omar Farouk Kamlin2,4,6,
  5. Peter G Davis2,4,6
  1. 1 Department of Paediatrics, Royal Hospital for Children Glasgow, Glasgow, UK
  2. 2 Newborn Research Centre, Royal Women’s Hospital, Melbourne, Victoria, Australia
  3. 3 Neonatal Unit, University Hospital of North Tees, Stockton-on-Tees, UK
  4. 4 Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
  5. 5 PIPER-Neonatal Retrieval Service, The Royal Children’s Hospital, Melbourne, Victoria, Australia
  6. 6 Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia
  1. Correspondence to Dr Joyce E O’Shea, Department of Neonatology, Maternity Building, Royal Hospital for Children, 1345 Govan Road, Glasgow G51 4TF, Scotland, UK; Joyce.O%E2%80%99Shea{at}


Objectives Neonatal intubation is a difficult skill to learn and teach. If an attempt is unsuccessful, the intubator and instructor often cannot explain why. This study aims to review videolaryngoscopy recordings of unsuccessful intubations and explain the reasons why attempts were not successful.

Study design This is a descriptive study examining videolaryngoscopy recordings obtained from a randomised controlled trial that evaluated if neonatal intubation success rates of inexperienced trainees were superior if they used a videolaryngoscope compared with a laryngoscope. All recorded unsuccessful intubations were included and reviewed independently by two reviewers blinded to study group. Their assessment was correlated with the intubator’s perception as reported in a postintubation questionnaire. The Cormack-Lehane classification system was used for objective assessment of laryngeal view.

Results Recordings and questionnaires from 45 unsuccessful intubations were included (15 intervention and 30 control). The most common reasons for an unsuccessful attempt were oesophageal intubation and failure to recognise the anatomy. In 36 (80%) of intubations, an intubatable view was achieved but was then either lost, not recognised or there was an apparent inability to correctly direct the endotracheal tube. Suctioning was commonly performed but rarely improved the view.

Conclusions Lack of intubation success was most commonly due to failure to recognise midline anatomical structures. Trainees need to be taught to recognise the uvula and epiglottis and use these landmarks to guide intubation. Excessive secretions are rarely a factor in elective and premedicated intubations, and routine suctioning should be discouraged. Better blade design may make it easier to direct the tube through the vocal cords.

  • intubation
  • neonate
  • medical education
  • videolarygoscopy
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  • Contributors JEOS and PL wrote the first draft of the manuscript. All authors are responsible for the reported research. All authors have participated in the concept and design; analysis and interpretation of data; and drafting or revising the manuscript. All authors have approved the manuscript as submitted.

  • Funding Funded by the Royal Women’s Hospital, Melbourne, Australia. COFK and MT are recipients of National Health and Medical Research Council (NHMRC) Early Career Fellowships Scholarships. PGD is a recipient of an NHMRC Practitioner Fellowship. The study was supported in part by an NHMRC Program Grant No. 384100.

  • Competing interests None declared.

  • Ethics approval The Royal Women’s Hospital research and ethics committees approved the study.

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

  • Correction notice This article has been corrected since it was published Online First. Additional text has been added to the Funding statement.

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