Cross-over study of novice intubators performing endotracheal intubation in an upright versus supine position.
There are a number of potential physical advantages to performing orotracheal intubation in an upright position. The objective of this study was to measure the success of intubation of a simulated patient in an upright versus supine position by novice intubators after brief training. This was a cross-over design study in which learners (medical students, physician assistant students, and paramedic students) intubated mannequins in both a supine (head of the bed at 0°) and upright (head of bed elevated at 45°) position. The primary outcome of interest was successful intubation of the trachea. Secondary outcomes included log time to intubation, Cormack-Lehane view obtained, Percent of Glottic Opening score, provider assessment of difficulty, and overall provider satisfaction with the position. There were a total of 126 participants: 34 medical students, 84 physician assistant students, and 8 paramedic students. Successful tracheal intubation was achieved in 114 supine attempts (90.5 %) and 123 upright attempts (97.6 %; P = 0.283). Upright positioning was associated with significantly faster log time to intubation, higher likelihood of achieving Grade I Cormack-Lehane view, higher Percent of Glottic Opening score, lower perceived difficulty, and higher provider satisfaction. A subset of 74 participants had no previous intubation training or experience. For these providers, there was a non-significant trend toward improved intubation success with upright positioning vs supine positioning (98.6 % vs. 87.8 %, P = 0.283). For all secondary outcomes in this group, upright positioning significantly outperformed supine positioning.
Department of Emergency Medicine, Indiana University School of Medicine, 720 Eskenazi Avenue, Fifth Third Faculty Office Building, 3rd Floor Emergency Medicine Office, Indianapolis, IN, 46202, USA. turnjose@iu.edu.
Joseph S
JS
Turner
Department of Emergency Medicine, Indiana University School of Medicine, 720 Eskenazi Avenue, Fifth Third Faculty Office Building, 3rd Floor Emergency Medicine Office, Indianapolis, IN, 46202, USA.
Timothy J
TJ
Ellender
Department of Emergency Medicine, Indiana University School of Medicine, 720 Eskenazi Avenue, Fifth Third Faculty Office Building, 3rd Floor Emergency Medicine Office, Indianapolis, IN, 46202, USA.|Carolinas Medical Center Emergency Medicine Residency, Medical Education Bldg., Third Floor 1000 Blythe Blvd., Charlotte, NC, 28203, USA.
Enola R
ER
Okonkwo
Department of Emergency Medicine, Indiana University School of Medicine, 720 Eskenazi Avenue, Fifth Third Faculty Office Building, 3rd Floor Emergency Medicine Office, Indianapolis, IN, 46202, USA.
Tyler M
TM
Stepsis
Department of Emergency Medicine, Indiana University School of Medicine, 720 Eskenazi Avenue, Fifth Third Faculty Office Building, 3rd Floor Emergency Medicine Office, Indianapolis, IN, 46202, USA.
Andrew C
AC
Stevens
Department of Anesthesia, Indiana University School of Medicine, Fesler Hall Room 204, 1130 West Michigan Street, Indianapolis, IN, 46202-5115, USA.
Christopher S
CS
Eddy
Department of Emergency Medicine, Indiana University School of Medicine, 720 Eskenazi Avenue, Fifth Third Faculty Office Building, 3rd Floor Emergency Medicine Office, Indianapolis, IN, 46202, USA.|Southern Illinois University Emergency Medicine Residency, 801 North Rutledge, PO Box 19638, Springfield, IL, 62794-9638, USA.
Erik G
EG
Sembroski
Department of Emergency Medicine, Indiana University School of Medicine, 720 Eskenazi Avenue, Fifth Third Faculty Office Building, 3rd Floor Emergency Medicine Office, Indianapolis, IN, 46202, USA.
Anthony J
AJ
Perkins
Department of Emergency Medicine, Indiana University School of Medicine, 720 Eskenazi Avenue, Fifth Third Faculty Office Building, 3rd Floor Emergency Medicine Office, Indianapolis, IN, 46202, USA.
Dylan D
DD
Cooper
D002983:Clinical Competence / Q000592:standards / Q000706:statistics & numerical data; D018592:Cross-Over Studies; D004635:Emergency Medicine / Q000193:education* / Q000706:statistics & numerical data; D006282:Health Personnel / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007196:Indiana; D007442:Intubation, Intratracheal / Q000379:methods* / Q000592:standards* / Q000706:statistics & numerical data; D007828:Laryngoscopy / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D016015:Logistic Models; D008348:Manikins; D016544:Patient Simulation; D013334:Students / Q000706:statistics & numerical data; D016683:Supine Position; D013997:Time Factors
Airway management; Education; Intubation; Simulation