Video-assisted instruction improves the success rate for tracheal intubation by novices

• Published in: British journal of anaesthesia : BJA Vol. 101; no. 4; pp. 568 - 572
• Main Authors: Howard-Quijano, K.J., Huang, Y.M., Matevosian, R., Kaplan, M.B., Steadman, R.H.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.10.2008; Oxford University Press; Oxford Publishing Limited (England)
• Subjects: anaesthetic techniques; anaesthetic techniques, laryngoscopy; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthesiology - education; Biological and medical sciences; Clinical Competence; Cross-Over Studies; education; Education, Medical, Graduate - methods; equipment, laryngoscopes; equipment, videos; Feedback, Psychological; Humans; Intubation, Intratracheal - methods; Intubation, Intratracheal - standards; laryngoscopes; laryngoscopy; Laryngoscopy - methods; Laryngoscopy - standards; Medical sciences; Prospective Studies; Teaching - methods; videos; equipment, laryngoscopes; education; equipment, videos; anaesthetic techniques, laryngoscopy; laryngoscopes; equipment; laryngoscopy; education; equipment; Anesthesia; videos; Intubation; Laryngoscope; anaesthetic techniques
• ISSN: 0007-0912; 1471-6771
• DOI: 10.1093/bja/aen211

Tracheal intubation via laryngoscopy is a fundamental skill, particularly for anaesthesiologists. However, teaching this skill is difficult since direct laryngoscopy allows only one individual to view the larynx during the procedure. The purpose of this study was to determine if video-assisted laryngoscopy improves the effectiveness of tracheal intubation training. In this prospective, randomized, crossover study, 37 novices with less than six prior intubation attempts were randomized into two groups, video-assisted followed by traditional instruction (Group V/T) and traditional instruction followed by video-assisted instruction (Group T/V). Novices performed intubations on three patients, switched groups, and performed three more intubations. All trainees received feedback during the procedure from an attending anaesthesiologist based on standard cues. Additionally, during the video-assisted part of the study, the supervising anaesthesiologist incorporated feedback based on the video images obtained from the fibreoptic camera located in the laryngoscope. During video-assisted instruction, novices were successful at 69% of their intubation attempts whereas those trained during the non-video-assisted portion were successful in 55% of their attempts (P=0.04). Oesophageal intubations occurred in 3% of video-assisted intubation attempts and in 17% of traditional attempts (P<0.01). The improved rate of successful intubation and the decreased rate of oesophageal intubation support the use of video laryngoscopy for tracheal intubation training.