Presented at the Neonatal Society 2015 Summer Meeting.
O’Shea JE1,2, Thio M1,3,4, Kamlin COF1,3,5, McGrory L1,6, Wong C1, John J1, Roberts C1,3, Kuschel C1,3, Davis PG1,3,5
1 Royal Women’s Hospital, Melbourne, Australia
2 Southern General Hospital, Glasgow, UK
3 University of Melbourne, Australia
4 PIPER Neonatal Transport, Melbourne, Australia
5 Murdoch Children’s Research Institute, Melbourne, Australia
6 University of Dundee, Dundee, UK
Background: Endotracheal intubation is a mandatory skill for neonatal trainees. However, success rates have fallen to <50% amongst junior doctors, largely due to declining opportunities to intubate. Videolaryngoscopy allows the instructor to share the same view of the pharynx as the trainee. We compared neonatal intubations guided by an instructor watching images on a videolaryngoscope screen with the traditional method where the instructor does not have this view.
Methods: A randomized, controlled trial at a tertiary neonatal centre recruited from February 2013 until 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 less than six 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: 206 first attempt intubations were analysed. Median (IQR) infant gestation 29 (27-32) weeks and weight were 1142 (816 – 1750)g. The success rate when the instructor was able to view the videolaryngoscope screen was 66% (69/104) compared to 41% (42/102) when the screen was covered, (p<0.001), OR 2.81 (95%CI 1.54-5.17). When premedication was used, the success rate in the intervention group was 72% (56/78) compared to 44% (35/79) in the control group (p<0.001), OR 3.2 (95%CI 1.6 – 6.6).
Conclusion: Intubation success rates of inexperienced neonatal trainees significantly improved when the instructor was able to share their view on a videolaryngoscope screen.
Corresponding author: Joyce.O’Shea@ggc.scot.nhs.uk
Acknowledgements: We would like to thank the infants, their parents and the residents for their participation in the study, the staff at the Royal Women’s Hospital and In Vitro Technologies for their lease of the videolaryngoscope for the trial.