Just-In-Time Neonatal Endotracheal Intubation Simulation Training: A Randomized Controlled Trial

Abstract

To assess if simulation-based just-in-time training (JITT, short video and simulation) is superior to video training (5-minute video) in acquiring skill in neonatal endotracheal intubation (ETI). A Canadian multicenter randomized trial recruited junior residents who performed neonatal ETI from July 2017 to June 2021. The primary outcomes were overall and first attempt ETI success rate. Secondary outcomes included number of attempts, duration of attempts, ETI-related complications, and residents' confidence level. Statistical analysis included generalized estimating equations, mixed model analysis, Mann-Whitney test, and χ² tests. Sixty-five residents performed 139 ETI. The overall success rate was similar for both groups (67% vs 70%, P=.71). However, the first attempt success rate was higher for the simulation-based JITT group (54% vs 41%, P=.035). The mean duration of attempts was shorter (35 [SD, 9] vs 62 [SD, 9] seconds, P=.048) and the median number of attempts had a tendency to be lower for the simulation-based JITT group (1 [IQR, 1; 1] vs 1 [IQR, 1; 2], P=.02). There were more mucosal trauma events in the simulation-based JITT group (P=.02). Residents in both groups reported similar confidence level in performing ETI. Compared with video training, simulation-based JITT for neonatal ETI did not improve overall success rate. However, simulation-based JITT improved first attempt success rate and decreased the number and the duration of ETI attempts. With its positive clinical impact, simulation-based JITT can become an educational adjunct to neonatal ETI training for residents. ClinicalTrials.gov: NCT02809924.