PT - JOURNAL ARTICLE AU - O’Shea, Joyce E AU - Loganathan, Prakash AU - Thio, Marta AU - Kamlin, C Omar Farouk AU - Davis, Peter G TI - Analysis of unsuccessful intubations in neonates using videolaryngoscopy recordings AID - 10.1136/archdischild-2017-313628 DP - 2018 Sep 01 TA - Archives of Disease in Childhood - Fetal and Neonatal Edition PG - F408--F412 VI - 103 IP - 5 4099 - http://fn.bmj.com/content/103/5/F408.short 4100 - http://fn.bmj.com/content/103/5/F408.full SO - Arch Dis Child Fetal Neonatal Ed2018 Sep 01; 103 AB - 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.