VIDEO-ASSISTED ENDOTRACHEAL INTUBATION IN THE NEWBORN: ROLE IN TEACHING, SKILL ACQUISITION, AND TUBE PLACEMENT VERIFICATION.

Abstract

Background Endotracheal intubation (EI) in newborns is difficult, and skill acquisition may become more problematic as less time is spent in DR and NICU during training. The advantages of endoscopy lie in a wider angle of view, enlarged imaging and improved illumination. The Newborn Resuscitation Program (NRP) recommends EI attempts be limited to 20 seconds. NRP training includes EI on newborn manikin heads. Purpose This study investigates if video-assisted techniques help in acquiring these skills and if time to verification of successful EI is shortened using this technology. Method After standard NRP presentation, trainees attempted EI serially with three laryngoscopy techniques: standard SL, video-supervised VL, and video-guided modified VLM. VL implies intubation with the video laryngoscope, with assistant verbally guiding from screen images. In VLM, the ET is advanced via the blade groove and inserted under screen image viewing by the operator. Miller #1 blades and Storz videolaryngoscopy equipment were used for VL and VLM; images were recorded on a laptop computer. Number of EI attempts, success of EI, and time to verification of EI were recorded. Time to correct EI was recorded at chest movement on bag ventilation in SL by stopwatch, and until the double-line ET marker passed through the vocal cords in VL and VLM by image timer. Trainees completed questionnaires and comments were solicited. Results SL first EI attempt was successful in 18/23 participants; 5/23 needed three attempts. In VL and VLM, first EI attempt succeeded in 20/23 and 21/23, respectively; second attempt in 2/23 and 1/23; and third attempt in 1/23 and 1/23. Time (mean ± SD) to ET placement verification in SL was 30.5 ± 14.2 (range 15-60), in VL 14.2 ± 13.0 (4.1-68.2), and in VLM 15.4 ± 11.7 (6.0-48.2) seconds. Questionnaire results favored video-guided techniques over SL. Conclusion Video-assisted laryngoscopic endotracheal intubation technology may improve teaching important skills, lead to higher intubation success rates, improve speed of placement verification, leading to faster intervention, and may play a role in medicolegal documentation and review of procedures in difficult cases.