Videolaryngoscopy versus direct laryngoscopy in simulated pediatric intubation.
OBJECTIVE
We determine whether videolaryngoscopy results in a higher prevalence of first-attempt intubation success and improved glottic visualization than direct laryngoscopy when performed by pediatric emergency medicine providers in simulated patients.


METHODS
This was a cross-sectional study at a single institution. Fellows and faculty in pediatric emergency medicine were invited to participate. Each subject performed intubations on 3 simulators (newborn, infant, adult), using a videolaryngoscope; each simulator was intubated by each subject with and without use of video. Primary outcome was first-attempt intubation success; secondary outcome was percentage of glottic opening score (POGO).


RESULTS
Twenty-six participants performed 156 intubations; complete data were available for 148 intubations. First-attempt success in the neonate was 88%; in the infant, 79%; and in the adult, 60%. In the adult simulator, videolaryngoscopy use showed a first-attempt success in 81% of subjects compared with 39% with direct laryngoscopy (difference 43%; 95% confidence interval [CI] 18% to 67%). There was no difference in first-attempt success rates between videolaryngoscopy and direct laryngoscopy in the newborn or infant simulators. Videolaryngoscopy use led to increased POGO scores in all 3 simulators, with a difference of 25% (95% CI 2% to 48%) in newborn simulators, 23% (95% CI 2% to 48%) in infant simulators, and 42% (95% CI 18% to 66%) in adult simulators.


CONCLUSIONS
Videolaryngoscopy was associated with greater first-attempt success during intubation by pediatric emergency physicians on an adult simulator. POGO score was significantly improved in all 3 simulators with videolaryngoscopy.
Department of Pediatrics, Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA. donoghue@email.chop.edu
Aaron J
AJ
Donoghue
Anne M
AM
Ades
Akira
A
Nishisaki
Ellen S
ES
Deutsch
D000328:Adult; D000367:Age Factors; D002983:Clinical Competence / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007442:Intubation, Intratracheal / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D020704:Laryngoscopes / Q000592:standards / Q000706:statistics & numerical data; D007828:Laryngoscopy / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D008348:Manikins; D010372:Pediatrics / Q000706:statistics & numerical data; D017211:Treatment Failure; D016896:Treatment Outcome; D014741:Video Recording / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data