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.