P2C111: Multi-angle Video Assessment of Simulated Neonatal Intubation

Background: Neonatal intubation is a life-saving intervention though few objective markers of procedural proficiency have been described. Quantifying differences in technique between novice and experienced intubators is necessary to optimize training. There is limited video data regarding the technical aspects of neonatal intubation, particularly in preterm neonates. We aim to use multi-angle video technology to quantify differences in intubation success between novice and experienced providers.

Methods: Study subjects included attending neonatologists, neonatal hospitalists, neonatology fellows, pediatric residents, and neonatal nurse practitioners. “Novices” were defined as having < 10 successful neonatal intubations and/or < 1 year of experience working in a NICU. All other subjects were deemed “experts”.

Thirty-eight subjects performed three intubation attempts with a video laryngoscope on both term and preterm neonatal mannequins. Overhead, over-the-right-shoulder, lateral, and intraoral video were recorded. Using data from 5 novices and 5 experts, we performed a preliminary analysis of 1) time intervals between steps of intubation and 2) the Cormack-Lehane grade most reflective of the intraoral view. We also described whether the subject maintained visualization of the cords during the procedure.

Results: The distribution of Cormack-Lehane views obtained by novices and experts differed significantly for both term and preterm mannequins (Table 1). Experts were more likely to obtain Grade I views in the term mannequins and Grade IIa views in the preterm mannequins. Pooled time interval data demonstrated that experts and novices required similar amounts of time to visualize the cords, but experts completed intubation faster (Table 2). When intubating the term mannequin, experts maintained their view of the cords more frequently than novices.

Conclusion: Experts required less time to intubate, secondary to faster endotracheal tube (ETT) placement after cord visualization. This may be explained by the fact that experts were better able to maintain a view of the cords during insertion of the endotracheal tube.

Experts more reliably obtained Grade I views in the term mannequin and IIa views in the preterm mannequin. Interestingly, experts intubating the preterm mannequin never obtained Grade I views, despite a very high rate of intubation success and faster intubation overall.

We will continue video data analysis involving all 38 study subjects. Additional data to be correlated with the video analysis includes measurement of force, torque, and laryngoscope and ETT motion paths. We will determine which variables differentiate novices from experts to inform a more robust training in neonatal intubation.