Real-Time Intubation and Ventilation Feedback: A Randomized Controlled Simulation Study

• Published in: Pediatrics (Evanston) 2023-05, Vol.151 (5)
• Main Authors: Dvorsky, Robyn, Rings, Franziska, Bibl, Katharina, Roessler, Lisa, Kumer, Lisa, Steinbauer, Philipp, Schwarz, Hannah, Ritschl, Valentin, Schmölzer, Georg M, Berger, Angelika, Werther, Tobias, Wagner, Michael
• Format: Article
• Language: English
• Subjects: Feedback; Humans; Infant, Newborn; Intubation; Intubation, Intratracheal; Laryngoscopes; Laryngoscopy; Manikins; Mechanical ventilation; Pediatrics; Respiration; Respiratory function; Supervisors; Ventilation
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.2022-059839

This study aimed to determine the best educational application of a respiratory function monitor and a video laryngoscope. This study was a randomized controlled simulation-based trial, including 167 medical students. Participants had to execute ventilation and intubation maneuvers on a newborn manikin. Participants were randomized into 3 groups. In group A (no-access), the feedback devices were not visible but recording. In group B (supervisor-access), the feedback devices were visible to the supervisor only. In group C (full-access), both the participant and the supervisor had visual access. The two main outcome variables were the percentage of ventilations within the tidal volume target range (4-8mL/kg) and the number of intubation attempts. Group C achieved the highest percentage of ventilations within the tidal volume target range (full-access 63.6%, supervisor-access 51.0%, no-access 31.1%, P < .001) and the lowest mask leakage (full-access 34.9%, supervisor-access 46.6%, no-access 61.6%; A to B: P < .001, A to C: P < .001, B to C: P = .003). Overall, group C achieved superior ventilation quality regarding primary and secondary outcome measures. The number of intubation attempts until success was lowest in the full-access group (full-access: 1.29, supervisor-access: 1.77, no-access: 2.43; A to B: P = .001, A to C: P < .001, B to C: P = .015). Our findings confirm that direct visual access to feedback devices for supervisor and trainees alike considerably benefits outcomes and can contribute to the future of clinical education.