319 - Success rate and duration of orotracheal intubation of premature infants using a video laryngoscope as compared to direct laryngoscopy in a simulation-based setting

Sunday, April 30, 2023

3:30 PM – 6:00 PM ET

Poster Number: 319
Publication Number: 319.348

Nicolaus v. Salis-Soglio, University of Ulm, Germany, Freiburg, Baden-Wurttemberg, Germany; Helmut D. Hummler, Childrens Hospital University of Marburg, Germany, Hagnau, Baden-Wurttemberg, Germany; Schwarz Stephan, Kinder- und Jugendaerzte Guenzburg, Guenzburg, Bayern, Germany; Marc R. Mendler, University of Ulm, NICU, Ulm, Baden-Wurttemberg, Germany

Presenting Author(s)

Helmut D. Hummler, MD (he/him/his)

Director Division of Neonatology
Childrens Hospital University of Marburg, Germany
Hagnau, Baden-Wurttemberg, Germany

Background: Endotracheal intubation of very low birth weight infants (VLBWI) is an essential procedure during neonatal resuscitation and in NICUs, but experience of staff is often limited. Video laryngoscopy (VL) has been described as a tool to improve intubation skills. There is limited information available on its use in high-risk preterm infants.

Objective:

The aim of this study was to investigate whether VL is a useful tool to support airway management in high-risk premature infants in the hands of less experienced operators.

Design/Methods: In this crossover study of predominantly inexperienced caregivers participating in standardized classes of neonatal resuscitation participants were exposed in random sequence to VL and conventional direct laryngoscopy (DL) for endotracheal intubation of a VLBWI simulation manikin to measure total time, number of attempts, success rate on first attempt, view of the vocal cords and perceived subjective safety until successful intubation. Primary outcome was time until successful intubation.

Results: In our study group of 94 participants there was no significant difference in the total time (mean VL: 34s (+/- 24s); DL: 37s (+/- 28s), p = 0.246), while the number of intubation attempts using VL was significantly lower (mean VL: 1.22 (+/- 0.53); DL: 1.37 (+/- 0.60), p = 0.023). Success rate of VL during the first attempt was significantly higher (VL: 84%; DL 69%, p = 0.016), view of the vocal cords was significantly better and perceived subjective safety was increased using VL.

Conclusion(s): Although there was no significantly shorter duration until successful intubation, secondary outcomes suggest that with rather inexperienced operators, VL can be a useful tool to increase rate of successful endotracheal intubation of VLBWI and to improve their perceived safety during the procedure. We speculate that this may have an impact on mortality and/or morbidity.