Endotracheal intubation skills of pediatricians versus anesthetists in neonates and children

Sam J Van Sambeeck,Gijs D Vos,Sander M J Van Kuijk,Boris W Kramer,Petronella M Vermeulen

doi:10.1007/s00431-019-03395-8

Sam J Van Sambeeck, Gijs D Vos + Show 3 more

Open Access

https://doi.org/10.1007/s00431-019-03395-8

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Abstract

This study compares the performance of pediatricians and anesthetists in neonatal and pediatric endotracheal intubations (ETI) during simulated settings. Participants completed a questionnaire and performed an ETI scenario on a neonatal and a child manikin. The procedures were recorded with head cameras and cameras attached to standard laryngoscope blades. The outcomes were successful intubation, time to successful intubation, number of attempts, complications, total performance score, end-assessment rating, and an assessment whether the participant was sufficiently able to perform an ETI. Fifty-two pediatricians and 52 anesthetists were included. For the neonatal ETI, the rate of successful intubation was in favor of anesthetists although not significant. Anesthetists performed significantly better in all other outcomes. Of the pediatricians, 65% was rated sufficiently adept to perform a neonatal ETI vs 100% of the anesthetists. Pediatricians (29%) overestimated while anesthetists (33%) underestimated their performance in neonatal ETI. For the pediatric ETI, all outcomes were significantly better for anesthetists. Only 15% of all pediatricians were considered sufficiently able to perform pediatric ETI vs 94% of the anesthetists.Conclusion: Anesthetists are far more adept in performing ETI in neonates and children compared with pediatricians in a simulated setting. Complications are expected to occur less frequently and less seriously when anesthetists perform ETI.What is Known:• Endotracheal intubation (ETI) performed by inexperienced care providers can lead to unsuccessful and/or prolonged intubation attempts. This can cause complications such as hypoxemia, trauma to the oropharynx and larynx, and prolonged interruption of resuscitation, which results in a high morbidity/mortality.• Fifty to 60 real-life ETI procedures are needed before ETI can be performed with a 90% success rate. Despite this, 18% of providers still require some assistance even after performing 80 intubations. Skill fade will occur if there is too little exposure.What is New:• This study shows that, on both neonatal and child manikins, anesthetists perform better in ETI compared with pediatricians. Besides this, complications are expected to occur less frequently and less seriously when anesthetists are performing the ETIs on neonates and children.• In those countries where there are no clear interprofessional agreements made in general hospitals on who will perform ETI on neonates and children in acute care settings, these agreements are urgently necessary.

Highlights

Endotracheal intubation (ETI) is the golden standard for securing the airway in situations where the provider is unable to ventilate the patient adequately with a bag-and-mask or by a supraglottic airway device, or if an open airway is compromised [20, 24]
This study shows that, on both neonatal and child manikins, anesthetists perform better in ETI compared with pediatricians
Questionnaire responses of the participants about existing agreements on who is performing ETI in neonatal and pediatric acute care settings and who preferably should perform ETI are shown in Table 1 as well

Summary

Introduction

Endotracheal intubation (ETI) is the golden standard for securing the airway in situations where the provider is unable to ventilate the patient adequately with a bag-and-mask or by a supraglottic airway device, or if an open airway is compromised [20, 24]. In Dutch general hospitals, there is no pediatric intensive care specialist available who can perform pediatric ETI in acute settings. In these hospitals, due to the low incidence of critically ill children and newborns requiring an acute ETI [7, 11, 17], the pediatricians’ exposure to ETI is expected to be low [14, 17]. The study objectives are (1) to explore the actual exposure of general pediatricians and anesthetists to ETI in neonates and children; (2) to compare the intubation skills (success rate, intubation time, number of attempts, degree of laryngeal view, complications, and overall performance) of both groups in a neonatal and a child manikin setting; and (3) to compare the self-perceived capability of the ETI performance with the actual performance on the manikins

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