title: Telepresent intubation supervision is as effective as in-person supervision of procedurally naive operators.
abstract: BACKGROUND
  Telepresence is emerging in clinical and educational settings as a potential modality to provide expert guidance during remote airway management. This study aimed to compare the effectiveness of telepresent versus in-person supervision of tracheal intubation.
  
  
  METHODS
  A randomized, crossover study was performed in a university medical simulation center with 48 first- and second-year medical students with no formal procedural training in tracheal intubation. Each participant was assigned to receive each of four study arms in random sequence: (1) direct laryngoscopy (DL) with in-person supervision, (2) DL with telepresent supervision, (3) videolaryngoscopy (VL) with in-person supervision, and (4) VL with telepresent supervision. Telepresence was established with a smartphone (Apple [Cupertino, CA] iPhone(®)) via FaceTime(®) connection. The primary outcome measure was the time to successful intubation. Secondary outcome measures included first pass success rate and the number of blade and tube attempts.
  
  
  RESULTS
  There was no significant difference between in-person and telepresent supervision for any of the outcomes. The median difference (in-person versus telepresent) for time to intubation was -3 s (95% confidence interval [CI], -20 to 14 s). The odds ratio for first attempt success was 0.7 (95% CI, 0.3-1.3), and the rate ratio for extra number of blade attempts (i.e., attempts in addition to first) was 1.1 (95% CI, 0.7-1.7) and 1.4 (95% CI, 0.9-2.2) for extra number of tube attempts.
  
  
  CONCLUSIONS
  In this study population of procedurally naive medical students, telepresent supervision was as effective as in-person supervision for tracheal intubation.
authors.affiliation: 1 College of Medicine, University of Arizona , Tucson, Arizona.
authors.forename: Hannes
authors.initials: H
authors.lastname: Prescher
authors.forename: Emily
authors.initials: E
authors.lastname: Grover
authors.forename: Jarrod
authors.initials: J
authors.lastname: Mosier
authors.forename: Uwe
authors.initials: U
authors.lastname: Stolz
authors.forename: David E
authors.initials: DE
authors.lastname: Biffar
authors.forename: Allan J
authors.initials: AJ
authors.lastname: Hamilton
authors.forename: John C
authors.initials: JC
authors.lastname: Sakles
mesh_terms: D000046:Academic Medical Centers; D001130:Arizona; D002983:Clinical Competence; D003198:Computer Simulation; D018592:Cross-Over Studies; D004504:Education, Medical, Undergraduate / Q000379:methods; D004521:Educational Measurement; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D007828:Laryngoscopy / Q000193:education; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D009934:Organization and Administration; D013337:Students, Medical / Q000706:statistics & numerical data; D013686:Telemetry / Q000379:methods*; D055815:Young Adult
keywords: intubation; telemedicine; telepresence; videolaryngoscopy