The benefits of the video-laryngoscope in learning intubation for undergraduate medical students: A randomized crossover study in airway manikin

Abstract

IntroductionDirect laryngoscopy is the most widely used procedure for learning intubation. Video-laryngoscopy has become a well-established tool in managing of difficult laryngoscopies. Its contribution to teaching intubation for novices remains unclear.The aim of this study was to compare video-laryngoscopy using Medcaptain® laryngoscope and direct laryngoscopy using Macintosh laryngoscope in learning tracheal intubation on a low-fidelity manikin by novice learners. MethodsThis was a cross-sectional, randomized, cross-over study, including 35 inexperienced in laryngoscopy students in the 5th year of medical studies. It was carried out on a low fidelity upper airway management dummy. We did not include learners who had previously practiced intubation. After randomization, 18 learners started learning by procedural simulation with video-laryngoscopy (type Medcaptain®) then direct laryngoscopy (type Macintosh) and 17 learners started with direct laryngoscopy then video-laryngoscopy. Then, all learners performed 3 intubation trials by using direct laryngoscopy and video-laryngoscopy according to the pre-established order. The primary endpoint was the time needed to intubate. Secondary endpoints were, Cormack classification, difficulties encountered and learners’ satisfaction. ResultsThere was no significant difference in time needed to intubate between groups for the three attempts (p = 0.18, p = 0.45 and p = 0.1). The time needed to intubate by direct laryngoscopy was lower on the 1st and 3rd trials for learners who had started their training with video-laryngoscopy first (p = 0.02 and p = 0.01; respectively). There was no significant difference regarding the rate of successful intubation. The video-laryngoscopy allowed better visualization of vocal cords with more frequently noted Cormack I classification (p < 0.001, p = 0.002 and p < 0.001). The main difficulties encountered were the handling of the epiglottis and the tongue by the blade and the inserting the tracheal tube with no significant difference between the 2 techniques. Learners’ satisfaction was comparable. ConclusionVideo-laryngoscopy improved vocal cord exposure during intubation on a manikin for novice learners. Clinical trial registrationThis study has been registered in Clinical Trials database NCT05859542.