Simulator-based ultrasound training for identification of endotracheal tube placement in a neonatal intensive care unit using point of care ultrasound

• Published in: BMC medical education Vol. 20; no. 1; p. 409
• Main Authors: Ali, Khushboo Qaim, Soofi, Sajid Bashir, Hussain, Ali Shabbir, Ansari, Uzair, Morris, Shaun, Tessaro, Mark Oliver, Ariff, Shabina, Merali, Hasan
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 07.11.2020; BioMed Central; BMC
• Subjects: Capacity Building; Child; Child Health; Clinical Competence; College Faculty; Diagnostic ultrasonography; Endotracheal tube; Esophagus; Ethics; Health Services; Humans; Infant, Newborn; Informed Consent; Intensive care; Intensive Care Units, Neonatal; Intubation; Intubation, Intratracheal; Medical Education; Methods; Neonatal care; Neonatal intensive care; Neonates; Newborn babies; Ostomy; Pakistan; Patient simulation; Patients; Pediatrics; Point of care ultrasound; Point-of-Care Systems; Questionnaires; Resuscitation; Simulation; Skills; Study and teaching; Ultrasonic imaging; Ultrasonography; Ultrasound training; Pakistan; Canada; United States > US; Neonates; Point of care ultrasound; Simulation; Ultrasound training; Endotracheal tube; Resuscitation
• ISSN: 1472-6920; 1472-6920
• DOI: 10.1186/s12909-020-02338-4

Simulators are an extensively utilized teaching tool in clinical settings. Simulation enables learners to practice and improve their skills in a safe and controlled environment before using these skills on patients. We evaluated the effect of a training session utilizing a novel intubation ultrasound simulator on the accuracy of provider detection of tracheal versus esophageal neonatal endotracheal tube (ETT) placement using point-of-care ultrasound (POCUS). We also investigated whether the time to POCUS image interpretation decreased with repeated simulator attempts. Sixty neonatal health care providers participated in a three-hour simulator-based training session in the neonatal intensive care unit (NICU) of Aga Khan University Hospital (AKUH), Karachi, Pakistan. Participants included neonatologists, neonatal fellows, pediatric residents and senior nursing staff. The training utilized a novel low-cost simulator made with gelatin, water and psyllium fiber. Training consisted of a didactic session, practice with the simulator, and practice with intubated NICU patients. At the end of training, participants underwent an objective structured assessment of technical skills (OSATS) and ten rounds of simulator-based testing of their ability to use POCUS to differentiate between simulated tracheal and esophageal intubations. The majority of the participants in the training had an average of 7.0 years (SD 4.9) of clinical experience. After controlling for gender, profession, years of practice and POCUS knowledge, linear mixed model and mixed effects logistic regression demonstrated marginal improvement in POCUS interpretation over repeated simulator testing. The mean time-to-interpretation decreased from 24.7 (SD 20.3) seconds for test 1 to 10.1 (SD 4.5) seconds for Test 10, p < 0.001. There was an average reduction of 1.3 s (β = - 1.3; 95% CI: - 1.66 to - 1.0) in time-to-interpretation with repeated simulator testing after adjusting for the covariates listed above. We found a three-hour simulator-based training session had a significant impact on technical skills and performance of neonatal health care providers in identification of ETT position using POCUS. Further research is needed to examine whether these skills are transferable to intubated newborns in various health settings. ClinicalTrials.gov Identifier: NCT03533218 . Registered May 2018.