Board 399 - Research Abstract LMA/IO Placement Versus ETT/UVC Placement during Simulation in New NRP Trainees (Submission #471)

Abstract

Introduction/Background Endotracheal intubation is the preferred procedure taught in the Neonatal Resuscitation Program (NRP) when a secure airway is needed. Studies show that pediatric residents are successful only 21-62% of the time, often requiring multiple attempts and taking longer than recommended. The laryngeal mask airway (LMA) is an alternate device that can be used to provide a secure airway. The preferred procedure taught in NRP for obtaining emergency vascular access is umbilical venous catheter (UVC) placement. Studies have shown intraosseous (IO) insertion to require less skill and practice and take less time than UVC placement for emergency vascular access. Pediatric residents can take six times as long to place an emergency UVC compared to IO. The purpose of this study was to compare the success and time to establish a secure airway and emergency vascular access during simulated neonatal resuscitation using LMA/IO versus endotracheal tube (ETT)/UVC in new NRP trainees. Methods Seventeen fourth year medical students on a pediatric rotation were recruited. They completed NRP training two days prior to study participation. The participants viewed a video demonstration of the four skills (ETT, LMA, UVC and IO) and performed each procedure on a manikin or task trainer with guidance from an experienced NRP provider. The students then participated in a simulated delivery room scenario, where a secure airway and vascular access were needed. They were randomized to either LMA and IO or ETT and UVC. The scenarios were recorded for data collection and analysis. Data was also collected in real time by observers in the delivery room. After the delivery room scenario, the students were surveyed to assess experience and perceived confidence with each skill. Results Success of LMA placement was 100% versus 62.5% with ETT (p = 0.082). The median number of attempts was 1 for the LMA versus 2.5 for ETT (p = .009). The median total airway management time using LMA was 88 seconds versus 173 seconds with ETT (p < .001) and median procedure time of LMA insertion was 23 seconds, compared to 119 seconds for ETT (p = .015). The rate of success and median time to obtain vascular access using IO catheter versus UVC did not significant differ (both p > 0.4). Conclusion In this pilot study in a simulated delivery room setting, there was a statistically significant difference in the time to placement and number of attempts favoring LMA versus ETT. IO insertion was faster than UVC placement, although not statistically significant with the small sample size. If larger studies support our findings, NRP training may need to include LMA as the preferred method for a secure airway, particularly in those who do not routinely perform delivery room resuscitation. Disclosures None.