P2A354: Efficacy of Novel Articulating Video Intubation Device (AVID) for Pediatric Airway versus the Glidescope Video Laryngoscopy (VL)

Background: The introduction of video technology represents a major advancement in devices used for intubation but represents a new host of challenges in successful airway securement. Pediatric emergency airways have been documented to have a high failure rate and newer technologies have not largely improved outcomes. We have designed a unique video stylet to help mitigate these challenges and compared its ease of use to video laryngoscopy.

Methods: Using an iterative design model, a pediatric video intubation device unique in its ability to articulate and housing a recessed camera was tested in a randomized controlled fashion against video laryngoscopy, using a commercially available Glidescope. A total of 33 participants from a single institution were recruited from anesthesia, surgery and critical care. All had previous experience with intubation and had privileges to intubate at their hospital. Participants were randomized to intubate with the VL and AVID or AVID and VL for a total of 5 times each. Successful intubation was defined as air inflation of the lungs on the model. Acceptable and unacceptable failure rates for the AVID were set at 16% and 32%, respectively, for CUSUM analysis and creation of a learning curve. We deployed a validated survey methodology (in publication review) for evaluation of the new tool (EIS).

Results: A total of 330 intubations were observed for this study; 165 with the AVID and 165 with the VL. There were 326 successful intubations. There were 4 failed intubations, 3 in the AVID group and 1 in the VL group with no statistical difference in the number of failed intubations (p=0.31). The mean time to intubation with the AVID was 18.62s (+/- 5.22s) and the VL 19.16 (+/- 6.91s) (p=0.19). There was a negative trend on CUSUM analysis consistent with the high number of successful intubations (Figure 1). Survey data showed all users found the new tool efficacious and felt confident in its use with only five intubation attempts.

Conclusion: The introduction of a recessed camera and articulating tip to a video guided intubation device appears to improve the time to intubation and provides an improved learning curve and user-confidence in pediatric airway management and manipulation. Further investigation is needed to show superiority and determine criteria for proficiency in intubation using the AVID.