Videolaryngoscopy to Teach Neonatal Intubation: A Randomized Trial.
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.
Department of Newborn Research, Royal Women's Hospital, Melbourne, Australia; Department of Paediatrics, Royal Hospital for Children, Glasgow, Scotland; University College Cork, Cork, Ireland; University of Glasgow, Glasgow, Scotland; joyce.o'shea@ggc.scot.nhs.uk.
Joyce E
JE
O'Shea
Department of Newborn Research, Royal Women's Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia; PIPER-Neonatal Transport, The Royal Children's Hospital Melbourne, Australia;
Marta
M
Thio
Department of Newborn Research, Royal Women's Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia; and.
C Omar
CO
Kamlin
Department of Newborn Research, Royal Women's Hospital, Melbourne, Australia; University of Dundee, Dundee, Scotland.
Lorraine
L
McGrory
Department of Newborn Research, Royal Women's Hospital, Melbourne, Australia;
Connie
C
Wong
Department of Newborn Research, Royal Women's Hospital, Melbourne, Australia;
Jubal
J
John
Department of Newborn Research, Royal Women's Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia;
Calum
C
Roberts
Department of Newborn Research, Royal Women's Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia;
Carl
C
Kuschel
Department of Newborn Research, Royal Women's Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia; and.
Peter G
PG
Davis
D006801:Humans; D007231:Infant, Newborn; D007396:Internship and Residency / Q000379:methods*; D007442:Intubation, Intratracheal; D007828:Laryngoscopy; D010372:Pediatrics / Q000193:education*; D014741:Video Recording