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O'Connell J, Weiner G. Intubating extremely premature newborns: a randomised crossover simulation study. BMJ Paediatr Open 2017; 1:e000157. [PMID: 29637161 PMCID: PMC5862193 DOI: 10.1136/bmjpo-2017-000157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 08/11/2017] [Accepted: 08/14/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Determine whether tracheal intubation of extremely low birthweight (ELBW) neonates is more successful with a size-0 or size-00 Miller laryngoscope blade. DESIGN Randomised crossover simulation study. SETTING Simulated neonatal intensive care unit environment. STUDY SUBJECTS Neonatology physicians and nurse practitioners (n=55). INTERVENTIONS Subjects performed four intubations in succession on a high-fidelity ELBW manikin with size-0 Miller and size-00 Miller blades from two different manufacturers. The intubation sequence was randomised. Intubations were recorded and scored for time analysis. Subjects completed surveys about blade preferences before and after completing the series of intubations. MAIN OUTCOME MEASURES Total laryngoscopy time and first attempt success in less than 30 s. RESULTS There was no difference in total laryngoscopy time (median 23.7 vs 20.6 s) or first attempt success in <30 s (67.3% vs 69.1%) between the size-0 and size-00 blades. Differences were noted between the same size blades made by different manufacturers. Among subjects expressing a prestudy blade size preference, there was no difference in laryngoscopy time or first attempt success between blades. Regardless of blade size, subjects were less successful with the first blade in the randomised sequence. CONCLUSIONS Our findings support the Neonatal Resuscitation Program recommendation identifying the size-00 blade as optional equipment. Operators need to be aware of design variations between manufacturers and they may benefit from 'just-in-time' training with a manikin prior to intubating a live patient.
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Affiliation(s)
- Joseph O'Connell
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan, USA
| | - Gary Weiner
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan, USA
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O'Shea JE, Thio M, Kamlin CO, McGrory L, Wong C, John J, Roberts C, Kuschel C, Davis PG. Videolaryngoscopy to Teach Neonatal Intubation: A Randomized Trial. Pediatrics 2015; 136:912-9. [PMID: 26482669 DOI: 10.1542/peds.2015-1028] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/26/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Neonatal endotracheal intubation is a necessary skill. However, success rates among junior doctors have fallen to <50%, largely owing to declining opportunities to intubate. Videolaryngoscopy allows instructor and trainee to share the view of the pharynx. We compared intubations guided by an instructor watching a videolaryngoscope screen with the traditional method where the instructor does not have this view. METHODS A randomized, controlled trial at a tertiary neonatal center recruited newborns from February 2013 to May 2014. Eligible intubations were performed orally on infants without facial or airway anomalies, in the delivery room or neonatal intensive care, by doctors with <6 months' tertiary neonatal experience. Intubations were randomized to having the videolaryngoscope screen visible to the instructor or covered (control). The primary outcome was first-attempt intubation success rate confirmed by colorimetric detection of expired carbon dioxide. RESULTS Two hundred six first-attempt intubations were analyzed. Median (interquartile range) infant gestation was 29 (27 to 32) weeks, and weight was 1142 (816 to 1750) g. The success rate when the instructor was able to view the videolaryngoscope screen was 66% (69/104) compared with 41% (42/102) when the screen was covered (P < .001, OR 2.81, 95% CI 1.54 to 5.17). When premedication was used, the success rate in the intervention group was 72% (56/78) compared with 44% (35/79) in the control group (P < .001, OR 3.2, 95% CI 1.6 to 6.6). CONCLUSIONS Intubation success rates of inexperienced neonatal trainees significantly improved when the instructor was able to share their view on a videolaryngoscope screen.
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Affiliation(s)
- Joyce E O'Shea
- Department of Newborn Research, Royal Women's Hospital, Melbourne, Australia; Department of Paediatrics, Royal Hospital for Children, Glasgow, Scotland; University College Cork, Cork, Ireland; University of Glasgow, Glasgow, Scotland; joyce.o'
| | - Marta Thio
- Department of Newborn Research, Royal Women's Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia; PIPER-Neonatal Transport, The Royal Children's Hospital Melbourne, Australia
| | - C Omar Kamlin
- Department of Newborn Research, Royal Women's Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia; and
| | - Lorraine McGrory
- Department of Newborn Research, Royal Women's Hospital, Melbourne, Australia; University of Dundee, Dundee, Scotland
| | - Connie Wong
- Department of Newborn Research, Royal Women's Hospital, Melbourne, Australia
| | - Jubal John
- Department of Newborn Research, Royal Women's Hospital, Melbourne, Australia
| | - Calum Roberts
- Department of Newborn Research, Royal Women's Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia
| | - Carl Kuschel
- Department of Newborn Research, Royal Women's Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia
| | - Peter G Davis
- Department of Newborn Research, Royal Women's Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia; and
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