title: Tracking manikin tracheal intubation using motion analysis.
abstract: OBJECTIVE
  This study investigates whether laryngoscope motion-tracking technology can be used to differentiate expert versus novice providers' techniques during endotracheal intubation in infant manikins; this may help improve intubation techniques.
  
  
  METHODS
  Each of 11 experts and 11 novices intubated an infant manikin head (Laerdal Corp, Wappinger Falls, NY) 10 times. Laryngoscope motion was tracked using electromagnetic technology during: (1) time from acquisition of laryngoscope to oral insertion, (2) insertion to stabilization of laryngoscope, and (3) stabilization of laryngoscope to insertion of endotracheal tube and withdrawal of laryngoscope. There were 213/220 analyzable data files. Expert versus novice rate of success, laryngoscope blade-tip motion path length, handle angle at intubation, time in each phase, and motion of handle relative to manikin were compared.
  
  
  RESULTS
  Intubation success rate was greater for experts (105/105 = 100% vs novices 101/108 = 93.5%, P < 0.001). Expert path of motion in phase 2 was longer (mean, 39 vs 29 cm, P < 0.001). The mean difference in the laryngoscope handle angle relative to the manikin occiput was statistically significant (mean angle, -54.42 vs -56.63 degrees; P = 0.001) but within the equipment testing margin of error (2 degrees). Time from insertion to withdrawal of laryngoscope (phases 2 and 3 combined) was greater for experts (16.45 vs 13.15 seconds; P = 0.02). Both experts and novices "rocked" the laryngoscope to achieve laryngeal visualization.
  
  
  CONCLUSIONS
  It is feasible to track laryngoscope motion during manikin intubation comparing expert versus novice technique. Experts had a greater success rate, but longer path length, and took longer to achieve manikin intubation. Motion-tracking technology may provide an analytic tool to improve techniques of intubation.
authors.affiliation: Center for Orthopedics Research and Development, Alfred I. duPont Hospital for Children and Nemours Children's Clinics, Wilmington, DE 19899, USA. trahman@nemours.org
authors.forename: Tariq
authors.initials: T
authors.lastname: Rahman
authors.forename: Swapna
authors.initials: S
authors.lastname: Chandran
authors.forename: David
authors.initials: D
authors.lastname: Kluger
authors.forename: Joseph
authors.initials: J
authors.lastname: Kersch
authors.forename: Laurens
authors.initials: L
authors.lastname: Holmes
authors.forename: Akira
authors.initials: A
authors.lastname: Nishisaki
authors.forename: Ellen S
authors.initials: ES
authors.lastname: Deutsch
mesh_terms: D002983:Clinical Competence; D005240:Feasibility Studies; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal; D007828:Laryngoscopy; D008348:Manikins; D010865:Pilot Projects