Abstract
Background:
To study the impact of videolaryngoscopy (VL) on intubation success among pediatric trainees compared with direct laryngoscopy (DL).
Methods:
One hundred pediatric residents were enrolled in a randomized, crossover, simulation study comparing VL to DL. Following a didactic session on neonatal intubation, residents intubated a standard neonatal mannequin. Three Neonatal Resuscitation Program (NRP) scenarios were then conducted, followed by a mannequin intubation with the alternate device. Number of attempts and time to intubation were recorded for all intubations.
Results:
Proportion of successful intubations on first attempt was greater with VL compared with DL (88% versus 63%; P=0.008). The DL group increased success after crossover with VL (63% versus 89%; P=0.008). Exposure to VL also reduced intubation time after device crossover (median intubation time: 31 versus 17 s; P=0.048).
Conclusions:
VL increased the success of endotracheal intubation by pediatric residents in simulation, with skills transferrable to DL.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Rent or buy this article
Prices vary by article type
from$1.95
to$39.95
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
International Liaison Committee on Resuscitation. The International Liaison Committee on Resuscitation (ILCOR) consensus on science with treatment recommendations for pediatric and neonatal patients: neonatal resuscitation. Pediatrics 2006; 117 (5): e978–e988.
Perlman JM, Risser R . Cardiopulmonary resuscitation in the delivery room: associated clinical events. Arch Pediatr Adolesc Med 1995; 149: 20–25.
Barber CA, Wyckoff MH . Use and efficacy of endotracheal versus intravenous epinephrine during neonatal cardiopulmonary resuscitation in the delivery room. Pediatrics 2006; 118 (3): 1028–1034.
Kattwinkel J, Perlman JM, Aziz K, Colby C, Fairchild K, Gallagher J et al. Part 15: neonatal resuscitation: 2010 American Heart Association Guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2010; 122 (18.Suppl 3): S909–S919.
O'Donnell CP, Kamlin CO, Davis PG, Morley CJ . Endotracheal intubation attempts during neonatal resuscitation: success rates, duration, and adverse effects. Pediatrics 2006; 117 (1): e16–e21.
Leone TA, Rich W, Finer NN . Neonatal intubation: success of pediatric trainees. J Pediatr 2005; 146 (5): 638–641.
Bismilla Z, Finan E, McNamara PJ, LeBlanc V, Jefferies A, Whyte H . Failure of pediatric and neonatal trainees to meet Canadian Neonatal Resuscitation Program standards for neonatal intubation. J Perinatol 2010; 30 (3): 182–187.
Weiner GM . Textbook of Neonatal Resuscitation. 7th edn, American Academy of Pediatrics and American Heart Association: Elk Grove Village, IL, USA, 2016.
Kahn DJ, Spinazzola R . Acquired oral commissure defect: a complication of prolonged endotracheal intubation. J Perinatol 2005; 25 (9): 612–614.
Maharaj CH, Costello JF, Higgins BD, Harte BH, Laffey JG . Learning and performance of tracheal intubation by novice personnel: a comparison of the Airtraq and Macintosh laryngoscope. Anaesthesia 2006; 61 (7): 671–677.
Venkatesh V, Ponnusamy V, Anandaraj J, Chaudhary R, Malviya M, Clarke P et al. Endotracheal intubation in a neonatal population remains associated with a high risk of adverse events. Eur J Pediatr 2011; 170 (2): 223–227.
Wallenstein MB, Birnie KL, Arain YH, Yang W, Yamada NK, Huffman LC et al. Failed endotracheal intubation and adverse outcomes among extremely low birth weight infants. J Perinatol 2016; 36 (2): 112–115.
Lockwood CJ, Lemons JA . Guidelines for Perinatal Care. 6th edn, American Academy of Pediatrics and American College of Obstetricians and Gynecologists: Elk Grove Village, IL, USA, 2007.
Feigin RD, Drutz JE, Smith EO, Collins CR . Practice variations by population: training significance. Pediatrics 1996; 98 (2): 186–192.
Falck AJ, Escobedo MB, Baillargeon JG, Villard LG, Gunkel JH . Proficiency of pediatric residents in performing neonatal endotracheal. Pediatrics 2003; 112 (6): 1242–1247.
Downes KJ, Narendran V, Meinzen-Derr J, McClanahan S, Akinbi HT . The lost art of intubation: assessing opportunities for residents to perform neonatal intubation. J Perinatol 2012; 32 (12): 927–932.
Weiss M, Schwarz U, Dillier CM, Gerber AC . Teaching and supervising tracheal intubation in paediatric patients using videolaryngoscopy. Pediatr Anesth 2011; 11 (3): 16–21.
Pott LM, Murray WB . Review of video laryngoscopy and rigid fiberoptic laryngoscopy. Curr Opin Anaesthesiol 2008; 21 (6): 750–758.
Lingappan K, Arnold JL, Shaw TL, Fernandes CJ, Pammi M . Videolaryngoscopy versus direct laryngoscopy for tracheal intubation in neonates. Cochrane Database of Systematic Reviews 2015, Issue 2. Art. No.: CD009975.
Vanderhal AL, Berci G, Simmons CF Jr., Hagiike M . A videolaryngoscopy technique for the intubation of the newborn: preliminary report. Pediatrics 2009; 124 (2): e339–e346.
Assaad MA, Lachance C, Moussa A . Learning neonatal intubation using the videolaryngoscope: a randomized trial on mannequins. Simul Healthc 2016; 11 (3): 190–193.
Moussa A, Luangxay Y, Tremblay S, Lavoie J, Aube G, Savoie E et al. Videolaryngoscope for teaching neonatal endotracheal intubation: a randomized controlled trial. Pediatrics 2016; 137 (3): e20152156.
Narang AT, Oldeg PF, Medzon R, Mahmood AR, Spector JA, Robinett DA . Comparison of intubation success of video laryngoscopy versus direct laryngoscopy in the difficult airway using high-fidelity simulation. Simul Healthc 2009; 4 (3): 160–165.
Volz S, Stevens TP, Dadiz R . A randomized controlled trial: does guidance using video laryngoscopy improve residents' success in neonatal intubations? E-PAS 2016; 228.
Gaies MG, Landrigan CP, Hafler JP, Sandora TJ . Assessing procedural skills training in pediatric residency programs. Pediatrics 2007; 120 (4): 715–722.
Oliver TK, Butzin DW, Guerin RO, Brownlee RC . Technical skills required in general pediatric practice. Pediatrics 1991; 88 (4): 670–673.
Walton DM, Edwards MC . Nationwide survey of pediatric residency training in newborn medicine: preparation for primary care practice. Pediatrics 2002; 110 (6): 1081–1087.
Pastores SM, O’Connor MF, Kleinpell RM, Napolitano L, Ward N, Bailey H et al. The Accreditation Council for Graduate Medical Education resident duty hour new standards: history, changes, and impact on staffing of intensive care units. Crit Care Med 2011; 39 (11): 2540–2549.
Mills DM, Williams DC, Dobson JV . Simulation training as a mechanism for procedural and resuscitation education for pediatric residents: a systematic review. Hosp Pediatr 2013; 3 (2): 167–176.
Vozenilek J, Huff JS, Reznek M, Gordon JA . See one, do one, teach one: advanced technology in medical education. Acad Emerg Med 2004; 11 (11): 1149–1154.
Kory PD, Eisen LA, Adachi M, Ribaudo VA, Rosenthal ME, Mayo PH . Initial airway management skills of senior residents: simulation training compared with traditional training. Chest 2007; 132 (6): 1927–1931.
O'Shea JE, Thio M, Kamlin CO, McGrory L, Wong C, John J et al. Videolaryngoscopy to teach neonatal intubation: a randomized trial. Pediatrics 2015; 136 (5): 912–919.
Koele-Schmidt L, Vasquez MM . NewB for newbies: a randomized control trial training housestaff to perform neonatal intubation with direct and videolaryngoscopy. Paediatr Anaesth 2016; 26 (4): 392–398.
Platts-Mills TF, Campagne D, Chinnock B, Snowden B, Glickman LT, Hendey GW . A comparison of GlideScope video laryngoscopy versus direct laryngoscopy intubation in the emergency department. Acad Emerg Med 2009; 16 (9): 866–871.
Inal MT, Memis D, Kargi M, Oktay Z, Sut N . Comparison of TruView EVO2 with Miller laryngoscope in paediatric patients. Eur J Anaesthesiol 2010; 27 (11): 950–954.
Singh R, Singh P, Vajifdar H . A comparison of Truview infant EVO2 laryngoscope with the Miller blade in neonates and infants. Paediatr Anaesth 2009; 19 (4): 338–342.
Fiadjoe J, Gurnaney H, Dalesio N, Sussman E, Zhao H, Zuemei Z et al. A prospective randomized equivalence trial of glidescope cobalt video laryngoscope to traditional direct laryngoscopy in neonates and infants. Anesthesiology 2012; 116 (3): 622–628.
Finan E, Bismilla Z, Campbell C, Leblanc V, Jefferies A, Whyte HE . Improved procedural performance following a simulation training session may not be transferable to the clinical environment. J Perinatol 2012; 32 (7): 539–544.
Patel J, Posencheg M, Ades A . Proficiency and retention of neonatal resuscitation skills by pediatric residents. Pediatrics 2012; 130 (3): 515–521.
Perlman J, Kattwinkel J, Wyllie J, Guinsburg R, Velaphi S, Nalini Singhal for the Neonatal ITFG. Neonatal resuscitation: in pursuit of evidence gaps in knowledge. Resuscitation 2012; 83 (5): 545–550.
Acknowledgements
We gratefully acknowledge and thank all the staff at the Texas Children’s Simulation Center and Baylor College of Medicine pediatrics and medicine pediatrics residents who participated in this study. We are also grateful to Matthew Scheer from Karl-Storz for loaning the equipment that made this study possible.
Author contributions
Shweta Parmekar wrote the first draft of this manuscript.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Parmekar, S., Arnold, J., Anselmo, C. et al. Mind the gap: can videolaryngoscopy bridge the competency gap in neonatal endotracheal intubation among pediatric trainees? a randomized controlled study. J Perinatol 37, 979–983 (2017). https://doi.org/10.1038/jp.2017.72
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/jp.2017.72
This article is cited by
-
Neonatal postgraduate training program for physician assistants: meeting a need in neonatal care
Journal of Perinatology (2019)