Video-assisted instruction improves the success rate for tracheal intubation by novices

Howard‐Quijano, Kimberly; Huang, Yue; Matevosian, Rima; Kaplan, Marshal B.; Steadman, Randolph H.

doi:10.1093/bja/aen211

Cited by 135 publications

(97 citation statements)

References 14 publications

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“…Therefore, proficiency needs to be achieved at intubation using direct laryngoscopy. There is only 1 previous randomized study in which the intubator performed direct laryngoscopy and the instructor was either able to see the images on the screen or not, a crossover study performed by Howard-Quijano et al 29 Intubations were randomized in blocks of 6 to either 3 with the screen visible to the instructor followed by 3 with the screen covered or the order reversed. The 6 intubations occurred over several days.…”

Section: Figurementioning

confidence: 99%

“…The success rate was significantly higher when the instructor was able to see the screen (69% compared with 55%, P = .04). 29 Videolaryngoscopes vary in style from modified traditional Miller or Macintosh laryngoscopes to devices with a short angulated blade and guide channel. Our hope was that the resident's experience performing laryngoscopy with the videolaryngoscope would be comparable to standard direct laryngoscopy so that the skill they learned could translate to standard practice.…”

Section: Figurementioning

confidence: 99%

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Videolaryngoscopy to Teach Neonatal Intubation: A Randomized Trial

et al. 2015

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BACKGROUND: Neonatal endotracheal intubation is a necessary skill. However, success rates among junior doctors have fallen to ,50%, largely owing to declining opportunities to intubate. Videolaryngoscopy allows instructor and trainee to share the view of the pharynx. We compared intubations guided by an instructor watching a videolaryngoscope screen with the traditional method where the instructor does not have this view.METHODS: A randomized, controlled trial at a tertiary neonatal center recruited newborns from February 2013 to May 2014. Eligible intubations were performed orally on infants without facial or airway anomalies, in the delivery room or neonatal intensive care, by doctors with ,6 months' tertiary neonatal experience. Intubations were randomized to having the videolaryngoscope screen visible to the instructor or covered (control). The primary outcome was first-attempt intubation success rate confirmed by colorimetric detection of expired carbon dioxide.RESULTS: Two hundred six first-attempt intubations were analyzed. Median (interquartile range) infant gestation was 29 (27 to 32) weeks, and weight was 1142 (816 to 1750) g. The success rate when the instructor was able to view the videolaryngoscope screen was 66% (69/104) compared with 41% (42/102) when the screen was covered (P , .001, OR 2.81, 95% CI 1.54 to 5.17). When premedication was used, the success rate in the intervention group was 72% (56/78) compared with 44% (35/79) in the control group (P , .001, OR 3.2, 95% CI 1.6 to 6.6).CONCLUSIONS: Intubation success rates of inexperienced neonatal trainees significantly improved when the instructor was able to share their view on a videolaryngoscope screen. WHAT'S KNOWN ON THIS SUBJECT:Endotracheal intubation is a mandatory skill for neonatal trainees. It is a difficult skill to acquire, and success rates of junior doctors are low and falling.WHAT THIS STUDY ADDS: Videolaryngoscopy allows the supervisor to share the intubator' s view of the airway and provide more informed guidance. Teaching intubation using a videolaryngoscope with the screen visible to the instructor results in significantly higher success rates for inexperienced doctors.

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Section: Figurementioning

confidence: 99%

Section: Figurementioning

confidence: 99%

Videolaryngoscopy to Teach Neonatal Intubation: A Randomized Trial

et al. 2015

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“…Novices achieved a 69% intubation success rate when trained with a V-MAC compared with a 55% success rate when trained with a Macintosh laryngoscope. 9 During their first 235 uses of the V-MAC, anesthesiologists achieved a 99.6% intubation success rate. 10 The V-MAC shortened the learning curve of both DL and video-laryngoscopy.…”

Section: Video-laryngoscopy In the Or In The Hands Of Anesthesiologismentioning

confidence: 99%

Review article: Video-laryngoscopy: another tool for difficult intubation or a new paradigm in airway management?

Paolini

Donati

Drolet

2012

Can J Anesth/J Can Anesth

162

149

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Background An adequate airway management plan is essential for patient safety. Recently, new tools have been developed as alternatives to direct laryngoscopy and intubation. Among these, video-laryngoscopy has enjoyed a rapid increase in popularity and is now considered by many as the first-line technique in airway management. This paradigm shift may have an impact on patient safety. Principal findings Studies show that video-laryngoscopes are associated with better glottic visualization, a higher success rate for difficult airways, and a faster learning curve, resulting in a higher success rate for intubations by novice physicians. Thus, unanticipated difficult intubations may be less frequent if video-laryngoscopy is used as the first-line approach. In addition, on-screen viewing by the operator creates a new dynamic interaction during airway management. The entire operating room team can assess progress in real time, which enhances communication and improves teaching. However, if video-laryngoscopes become standard tools for tracheal intubation, these more costly devices will need to be widely available in all locations where airway management is conducted. Furthermore, algorithms for difficult intubation will require modification, and the question of selecting alternate devices will arise. If the incidence of difficult intubation decreases, the lack of motivation to teach and learn the use of alternative devices might adversely impact patient safety.

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“…Video can also facilitate assessment with global rating scores [65]. A number of studies describe the benefit of imaging the larynx with videolaryngoscopes to assist instruction during training in laryngoscopy [66][67][68][69].…”

Section: ó 2011 the Authorsmentioning

confidence: 99%

Education in airway management

et al. 2011

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SummaryIn airway management, poor judgment, education and training are leading causes of patient morbidity and mortality. The traditional model of medical education, which relies on experiential learning in the clinical environment, is inconsistent and often inadequate. Curriculum change is underway in many medical organisations in an effort to correct these problems, and airway management is likely to be explicitly addressed as a clinical fundamental within any new anaesthetic curriculum. Competency‐based medical education with regular assessment of clinical ability is likely to be introduced for all anaesthetists engaged in airway management. Essential clinical competencies need to be defined and improvements in training techniques can be expected based on medical education research. Practitioners need to understand their equipment and diversify their airway skills to cope with a variety of clinical presentations. Expertise stems from deliberate practice and a desire constantly to improve performance with a career‐long commitment to education.

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Video-assisted instruction improves the success rate for tracheal intubation by novices

Abstract: The improved rate of successful intubation and the decreased rate of oesophageal intubation support the use of video laryngoscopy for tracheal intubation training.

Cited by 135 publications

References 14 publications

Videolaryngoscopy to Teach Neonatal Intubation: A Randomized Trial

Videolaryngoscopy to Teach Neonatal Intubation: A Randomized Trial

Review article: Video-laryngoscopy: another tool for difficult intubation or a new paradigm in airway management?

Education in airway management

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