P2C110: Ergonomic Assessment of Simulated Neonatal Intubation: Can We Define What Expert Intubators Do?

Background: Intubation requires manual dexterity and hand-eye coordination; proper positioning of the fingers and hands in relation to the laryngoscope, the endotracheal tube and the patient is key to successfully securing the airway. Historically, intubation has been described and assessed by subjective (“feel”) and crude objective (“in” or “out”) criteria. This reliance on subjective rather than objective performance markers severely impairs both the initial acquisition and the maintenance of this important skill. In neonates, intubation is in fact both a life-saving and a life-threatening intervention. Thus, the ability to define safe and successful neonatal intubation is critical to understanding how to acquire and maintain this skill.

Methods: Healthcare professionals who resuscitate newborns in the delivery rooms at our institution (Level 4 neonatal intensive care unit, ~4000 deliveries per year, high-risk obstetrics service) were recruited to participate in this study. Each subject performed 6 intubations of a full-term neonatal patient simulator and 6 intubations of a preterm neonatal patient simulator. Views from overhead and the right side of the bed were recorded with two digital cameras. During each intubation attempt, the best view of the vocal cords was verbalized by each subject; at this moment, a still photograph was extracted from the videorecordings at each camera angle to be used to generate an ergonomic assessment of each intubation attempt (see Table 1).

Results: Thirty-eight subjects participated in this study. Subjects included attending neonatologists, fellows in neonatology, neonatology hospitalists, neonatal nurse practitioners, neonatal transport nurses, and pediatric resident physicians. The self-reported level of intubation skill ranged from novice to expert.

Data analysis will be completed by August 2023. Degree of flexion at the subject’s hip will be measured by joint angle measurement at the hip using the DrGoniometer software applied to the still photographs. The remaining ergonomic position data points will be analyzed from the photographs using Adobe Photoshop software.

A test of normality will be performed to determine if data are normally distributed. If data are normally distributed, a paired samples t-test will be performed. If data are not normally distributed, a Wilcoxon signed-rank test will be performed. A Pearson correlation will performed to determine if there is a relationship between each ergonomic measurement and patient gestational age. For all statistical analyses, the alpha level will be set at 0.05.

Conclusion: The ability to successfully and safely perform intubation is an essential technical skill for physicians and advanced practice providers who are responsible for resuscitating, stabilizing, and caring for neonates. The application of human factors science to the technique of intubation will generate the objective data necessary to design objective training and assessment tools and improve the performance of healthcare professionals in this life-saving skill.