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The skill of tracheal intubation with rigid scopes - a randomised controlled trial comparing learning curves in 740 intubations.

ABSTRACT: BACKGROUND:Rigid scopes are successfully used for management of difficult airways, but learning curves have not been established. METHODS:This randomised controlled trial was performed at the University Hospital Bern in Switzerland to establish learning curves for the rigid scopes Bonfils and SensaScope and to assess their performance. Fifteen consultant anaesthetists and 15 anaesthesia registrars performed a total of 740 intubations (10 to 20 intubations with each device per physician) in adult patients without predictors of a difficult airway under general anaesthesia. According to randomisation, physicians intubated the patient's trachea with either the Bonfils or the SensaScope. A maximum of three intubation attempts was allowed. Primary outcome was overall time to successful intubation. Secondary outcome parameters included first attempt success, first attempt success within 60?s, failures and adverse events. RESULTS:A clear learning effect was demonstrated: Over 20 trials, intubations became 2.5-times quicker and first attempt intubation success probability increased by 21-28 percentage points. Fourteen and 20 trials were needed with the Bonfils and the SensaScope, respectively, to reach a 90% first attempt success probability. Intubation times were 23% longer (geometric mean ratio 1.23, 95% confidence interval 1.12-1.36, p?

SUBMITTER: Theiler L

PROVIDER: S-EPMC7565755 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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The skill of tracheal intubation with rigid scopes - a randomised controlled trial comparing learning curves in 740 intubations.

Theiler Lorenz L Greif Robert R Bütikofer Lukas L Arheart Kristopher K Kleine-Brueggeney Maren M

BMC anesthesiology 20201016 1

<h4>Background</h4>Rigid scopes are successfully used for management of difficult airways, but learning curves have not been established.<h4>Methods</h4>This randomised controlled trial was performed at the University Hospital Bern in Switzerland to establish learning curves for the rigid scopes Bonfils and SensaScope and to assess their performance. Fifteen consultant anaesthetists and 15 anaesthesia registrars performed a total of 740 intubations (10 to 20 intubations with each device per phys ...[more]

PMID: 33066735

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Project description:Background: Intubation of neonates is difficult and hazardous. Factors associated with procedure-related adverse events and unsuccessful intubation attempts are insufficiently evaluated, especially during neonatal nasotracheal intubations. Objective: Aim of this study was to determine the frequency of tracheal intubation-associated events (TIAEs) during neonatal nasotracheal intubations and to identify factors associated with TIAEs and unsuccessful intubation attempts in our neonatal unit. Methods: This was a prospective, single-site, observational study from May 2017 to November 2019, performed at a tertiary care neonatal intensive care unit in a German academic teaching hospital. All endotracheal intubation encounters performed by the neonatal team were recorded. Results: Two hundred and fifty-eight consecutive intubation encounters in 197 patients were analyzed. One hundred and forty-eight (57.4%) intubation encounters were associated with at least one TIAE. Intubation inexperience (<10 intubation encounters) (OR = 2.15; 95% CI, 1.257-3.685) and equipment problems (OR = 3.43; 95% CI, 1.12-10.52) were predictive of TIAEs. Intubation at first attempt (OR = 0.10; 95% CI, 0.06-0.19) and videolaryngoscopy (OR = 0.47; 96% CI, 0.25-0.860) were predictive of intubation encounters without TIAEs. The first intubation attempt was commonly done by pediatric residents (67.8%). A median of two attempts were performed until successful intubation. Restricted laryngoscopic view (OR = 3.07; 95% CI, 2.08-4.53; Cormack-Lehane grade 2 vs. grade 1), intubation by pediatric residents when compared to neonatologists (OR = 1.74; 95% CI, 1.265-2.41) and support by less experienced neonatal nurses (OR = 1.60; 95% CI, 1.04-2.46) were associated with unsuccessful intubation attempts. Conclusions: In our unit, TIAEs and unsuccessful intubation attempts occurred frequently during neonatal nasotracheal intubations. To improve success rates, quality improvement und further research should target interprofessional education and training, equipment problems and videolaryngoscopy.

Project description:IntroductionVomiting and regurgitation are commonly encountered in out-of-hospital cardiac arrest (OHCA), with a reported incidence of 20-30%. This is of concern since patients who have suffered an OHCA are already in extremis. If standard suctioning techniques are not sufficient to maintain a clear airway and provide ventilation, then these patients will die, irrespective of the quality of chest compressions and the timeliness of defibrillation. This study aimed to determine whether a short teaching session of the suction assisted laryngoscopy and airway decontamination (SALAD) technique improved paramedics' ability to successfully intubate a contaminated airway.MethodsA modified airway manikin with the oesophagus connected to a reservoir of 'vomit', and a bilge pump capable of propelling the vomit up into the oropharynx, was used to simulate a soiled airway. The intervention consisted of a brief SALAD training session with a demonstration and opportunity to practice. Participants were randomly allocated into two groups: AAB, who made two pre-training intubation attempts and one post-training attempt, and ABB, who made one pre-training and two post-training attempts, to adjust for improvement in performance due to repetition.ResultsIn this manikin study, following a brief SALAD training session, more paramedics were able to intubate a soiled airway on their first attempt, compared to those without training (90.2% vs. 53.7%, difference of 36.6%, 95% CI 24-49.1%, p < 0.001). In addition, the mean difference in time taken to perform a successful intubation between groups was statistically significant for attempts 1 and 2 (mean difference 11.71 seconds, 95% CI 1.95-21.47 seconds, p = 0.02), but not attempts 1 and 3 (mean difference -2.52 seconds, 95% CI -11.64-6.61 seconds, p = 0.58). This result is likely to be confounded by the use of tracheal suction, which only occurred in the post-training attempts and added additional time to the intubation attempts. There was no statistically significant difference in success rates on the third attempt between AAB and ABB (89.0% vs. 86.6%, difference 2.4%, 95% CI 7.6-12.4%, p = 0.63).ConclusionIn this study, the use of the SALAD technique significantly improved first attempt success rates when paramedics were intubating a simulated soiled airway.

Dataset Information

The skill of tracheal intubation with rigid scopes - a randomised controlled trial comparing learning curves in 740 intubations.

Publications

The skill of tracheal intubation with rigid scopes - a randomised controlled trial comparing learning curves in 740 intubations.

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