843: VIDEO LARYNGOSCOPY AND TEAM DYNAMICS DURING INTUBATION

Abstract

Introduction: Intubation in the pediatric intensive care unit (PICU) involves teamwork between a proceduralist and team leader. Improved team dynamics may minimize harm to patients during this high-risk procedure. Video laryngoscopy (VL) allows multiple team members to view the glottic anatomy. Although VL use has increased, little is known about its influence on team dynamics. Our aim was to compare cognitive load, team member stress, and provision of feedback during VL versus direct laryngoscopy (DL) intubations. Methods: We prospectively studied intubations performed by the critical care team for children < 18 years old in an academic PICU from November 2021 to May 2022. Proceduralists and team leaders completed brief surveys after each intubation. We defined cognitive load using the validated Paas scale (range: 0-9) and the NASA Task Load Index (NASA-TLX, range: 0-100 on each of six domains). Team members were also queried regarding stress levels, perceptions of feedback, and confidence in endotracheal tube placement. Chi squared analysis was used to compare DL and VL. Results: Among 45 intubations during the study period, 41 surveys were completed by the proceduralist and 39 surveys were completed by the team leader. When measured using the Paas scale, cognitive load did not differ between VL and DL for the proceduralist or the team leader (P>0.05). When measured using NASA-TLX, cognitive load only differed for the proceduralist in 2 domains: increased effort (62.7 with VL vs. 49.4 with DL, P=0.017) and reduced performance (41.9 with VL vs. 17.4 with DL, P=0.044). Stress levels did not differ between VL and DL (P>0.05). The proceduralist received feedback more often with VL than DL (100% vs. 68%, p=0.005), however the team lead did not perceive a difference in ease of giving feedback with VL versus DL (P>0.05). The team leader had increased confidence in correct endotracheal tube placement using VL versus DL (3 vs. 2.84, p = 0.04). Conclusions: Although VL allows for a shared mental model during intubation by projecting glottic anatomy onto a screen, its use does not reduce team stress or cognitive load. Furthermore, the proceduralist finds VL to require more effort and decrease performance compared to DL. This may be due to less familiarity with VL or use of VL in more clinically stressful situations.