Insert Program or Hospital Logo Introduction ► Due to changes in delivery room practices, improvement in clinical care, and limitations on the time spent in the Neonatal Intensive Care Unit, the opportunities to perform endotracheal intubation, in neonatal patients, have become limited for pediatric trainees. ► Most training programs rely on bedside teaching, online training modules, animal labs, or simulation based training to educate novice intubators. ► Video laryngoscopy offers a novel alternative to traditional teaching strategies as it allows the trainee and the instructor to share the view of procedure in real time. ► In simulated settings, trainees using video laryngoscopy and direct laryngoscopy have been reported to have similar intubation success. However, the role of video laryngoscopy as a supplemental teaching aid has not been fully explored. ► The objective of this study is to determine whether video laryngoscopy assisted curriculum, compared to a traditional direct laryngoscopy assisted curriculum, improves neonatal intubation performance in a simulated setting. Video Laryngoscopy vs. Direct Laryngoscopy in Teaching Neonatal Endotracheal Intubation: A Simulation Based Study Srikumar Nair, MD, MHSA; Eric Thomas, MD, MPH; Robert Lasky, PhD; Lakshmi Katakam, MD, MPH. University of Texas Health Science Center-Houston, Texas, United States Results Abstract Background: Video laryngoscopy has recently received much attention as a novel tool that enhances visualization of the airway. It is uncertain if improved visualization results in better intubation performance. In simulated settings, trainees using video laryngoscopy and direct laryngoscopy have been reported to have similar intubation success. The role of Video Laryngoscopy as a supplemental teaching aid has not been fully explored. Objective: To determine whether video laryngoscopy assisted curriculum, compared to a traditional direct laryngoscopy curriculum, improves neonatal intubation success in a simulated setting. Design/Methods: Randomized trial of novice intubators was conducted at University of Texas-Houston from 6/2013-8/2013. Pediatric residents, neonatology fellows, and respiratory therapy students, with history of fewer than 5 successful intubations, were given the opportunity to voluntarily enroll in the study. Eligible candidates were randomly assigned to direct laryngoscopy (control) or video laryngoscopy (intervention) group. All participants viewed a video presentation and participated in a skills session. Those in the intervention group received additional instruction with video Laryngoscopy videos and an opportunity to practice with Storz C- MAC TM video laryngoscope. Intubation skills were evaluated, at the end of the training sessions, using direct laryngoscopy and a SimNewB ® mannequin. The number of intubation attempts, outcome of each attempt, and time to success was recorded. Data were analyzed using Fishers exact and logistic regression where appropriate. Results: 123 trainees were enrolled, 62 in Direct Laryngoscopy group and 61 in the video laryngoscopy group. There were no significant differences in the baseline characteristics (gender, training level, subspecialty, or prior intubation experience) between the two groups. Intubation success on first attempt was achieved by 69% (43/62) of the direct laryngoscopy group vs. 61% (37/61) of the video laryngoscopy group, P=0.35. Time to successful intubation was 25 sec (IQR 18, 32) in the direct laryngoscopy group and 26.5 sec (IQR 20, 43) in the video laryngoscopy group, P=0.27. Those in the video laryngoscopy group were more likely to need >2 attempts to achieve intubation success, odds ratio=3.09 (95% CI ). Conclusions: In a simulated setting, teaching with a video laryngoscopy curriculum did not improve intubation performance, compared to teaching with direct laryngoscopy. It is uncertain if the cost and resources necessary for video laryngoscopy are justified. Further studies are needed to determine if video laryngoscopy based teaching has an impact on clinical intubation performance. Description of intervention/study Conclusions ► We found no significant improvement in trainee intubation performance in the simulated setting when comparing a video laryngoscopy derived curriculum to a traditional intubation training curriculum. ► The likelihood of intubation success was lower for the trainees exposed to a video laryngoscope based curriculum, compared to the trainees exposed to a traditional intubation curriculum, but it did not reach statistical significance. ► The time and number of attempts required to perform a successful intubation were not significantly different among those exposed to a video laryngoscope based curriculum and those exposed to a traditional intubation curriculum. ► The generalizability of these results is limited by the simulated nature of our study and the utility of the video laryngoscope as a teaching tool may be underappreciated in this setting. ► The value of video laryngoscopy as a training aid and its influence on clinical intubations needs to be further explored in order to justify its cost for routine use. Texas Pediatric Society Electronic Poster Contest Skills session: All participants were given 15 minutes to practice intubation skills on a newborn manikin head. Those in the video laryngoscopy group had access to a Storz C-MAC TM video laryngoscope (in addition to the traditional intubation equipment) to use at their discretion. Evaluation: Each subject was asked to perform an intubation on a SimNewB ® manikin using a traditional laryngoscope. Maximum of 5 intubation attempts were allotted to each subject. Successful intubation was defined as passage of endotracheal tube into the trachea, as confirmed by the simulator. The number of intubation attempts, outcome of each attempt, and time to successful intubation were recorded. ► Outcomes of interest: Primary outcome of interest was Intubation success on first attempt (yes/no). Secondary outcomes included the time to successful intubation (time from first introduction of the laryngoscope into the simulator’s mouth to the passage of the endotracheal tube into the trachea) and number of attempts required to achieve successful intubation of the SimNewB ® manikin. ► Sample size: We needed 49 patients in each group to have 80 percent power, alpha level of 0.05 and detect a 30% difference in our primary outcome of intubation success between the two study groups. ► Data analysis: Odds ratios were calculated to compare the odds of intubation success with exposure to video laryngoscopy curriculum vs. exposure to traditional curriculum. Data were analyzed using Fishers exact and logistic regression where appropriate. ► This is a single-center, randomized controlled trial that was conducted at the University of Texas at Houston Health Science Center from 06/ /2013. ► Study population: Novice intubators such as pediatric residents, neonatal fellows and respiratory therapy students with previous experience of five or fewer successful neonatal intubations were invited to participate in this study. ► Study procedures: Enrollment occurred on a voluntary basis and enrolled subjects were randomly assigned to the intervention arm (teaching with video laryngoscopy intubation curriculum) or the control arm (teaching with traditional intubation curriculum). ► Study participants were asked to complete a brief survey to describe their previous intubation experiences and then completed the following three segments of their assigned training curriculum. Didactic: A presentation describing the basics of neonatal airway management, indications for endotracheal intubation, equipment set up, and proper technique was given. In addition, those randomized to video laryngoscopy group watched a set of pre-recorded patient intubations that were done using a video laryngoscope.