Does seniority always correlate with simulated intubation performance? Comparing endotracheal intubation performance across medical students, residents, and physicians using a high-fidelity simulator

Background Endotracheal intubation is crucial in emergency medical care and anaesthesia. Our study employed a high-fidelity simulator to explore differences in intubation success rate and other skills between junior and senior physicians. Methods We examined the performance of 50 subjects, including undergraduate students (UGY), postgraduate trainees (PGY), residents (R), and attending physicians (VS). Each participant performed 12 intubations (i.e. 3 devices x 4 scenarios) on a high-fidelity simulator. Main outcome measures included success rate, time for intubation, force applied on incisor and tongue, and Cormack Lehane grades. Results There was no primary effect of seniority on any outcome measure except success rate and Cormack Lehane grades. However, VS demonstrated shorter duration than medical students using Glidescope and direct laryngoscopy, whereas VS and R applied significantly more force on the incisor in the normal airway and rigid neck scenario respectively. Discussion Seniority does not always correlate with skill perfection in detailed processes. Our study suggests that the use of video laryngoscopy enhances the intubation success rate and speed, but the benefit only accrues to senior learners, whereby they applied more force on the incisor at a single peak under difficult scenarios. These findings are discussed in terms of psychological and cognitive perspectives. Conclusion Speed and safety are essential for high quality critical medical procedures. A tool should be designed and implemented to educate junior physicians with an emphasis on practice and efficiency, which should also contribute to updating senior physicians’ knowledge and competence by providing instant feedback on their performance. This type of fine-grained feedback could serve as a complement to traditional training and provide a sustainable learning model for medical education.

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Effect of Rocuronium vs Succinylcholine on Endotracheal Intubation Success Rate Among Patients Undergoing Out-of-Hospital Rapid Sequence Intubation

JAMA ◽

10.1001/jama.2019.18254 ◽

2019 ◽

Vol 322 (23) ◽

pp. 2303 ◽

Cited By ~ 15

Author(s):

Bertrand Guihard ◽

Charlotte Chollet-Xémard ◽

Philippe Lakhnati ◽

Benoit Vivien ◽

Claire Broche ◽

...

Keyword(s):

Success Rate ◽

Endotracheal Intubation ◽

Rapid Sequence Intubation ◽

Rapid Sequence ◽

Intubation Success ◽

Intubation Success Rate

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Endotracheal Intubation in Patients With COVID-19 By Emergency Physicians in The Tokyo Metropolitan Area

10.21203/rs.3.rs-181495/v1 ◽

2021 ◽

Author(s):

Mitsuhito Soh ◽

Toru Hifumi ◽

Norio Otani ◽

Momoyo Miyazaki ◽

Kentaro Kobayashi ◽

...

Keyword(s):

Success Rate ◽

Endotracheal Intubation ◽

Metropolitan Area ◽

Patient Characteristics ◽

Emergency Physicians ◽

Related Factors ◽

Tokyo Metropolitan ◽

Tokyo Metropolitan Area ◽

Intubation Success ◽

Intubation Success Rate

Abstract Background: Patients with COVID-19 may require emergency tracheal intubation for mechanical ventilation by emergency physicians. However, the success rate, complications, operator safety, and issues around personal protective equipment (PPE) and barrier enclosure use are not known in this context.Methods: This was a retrospective study of data for adult patients with COVID-19 who underwent endotracheal intubation performed by emergency physicians at four hospitals in the Tokyo Metropolitan Area between January 2020 and September 2020. Patient characteristics, intubation-related factors, and intubation success and complications rates were obtained. Two analyses were then performed. In analysis 1, the intubation success rate in patients was compared among four groups using different types of PPE. In analysis 2, patients were compared by those intubated with or without barrier enclosure.Results: In total, 46 patients met the inclusion criteria, of whom 85% were successfully intubated at the first attempt, 27% experienced hypotension, and 27% experienced hypoxia. No muscle relaxants were used in 8.7% and the Macintosh blade was used in 37%. The four PPE types and the intubation confirmation methods varied considerably, but all met the WHO recommendations. A barrier enclosure device was used in 26%, with a success rate of approximately 80% irrespective of its use.Conclusions: The success rate at the first attempt of intubation was relatively high, albeit with a moderately high complication rate. All PPE types were safe, including when barrier enclosures were used. Success was not affected by using barrier enclosures.

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A Comparison of Paramedic First Pass Endotracheal Intubation Success Rate of the VividTrac VT-A 100, GlideScope Ranger, and Direct Laryngoscopy Under Simulated Prehospital Cervical Spinal Immobilization Conditions in a Cadaveric Model

Prehospital and Disaster Medicine ◽

10.1017/s1049023x17006872 ◽

2017 ◽

Vol 32 (6) ◽

pp. 621-624 ◽

Cited By ~ 2

Author(s):

Ryan Hodnick ◽

Tony Zitek ◽

Kellen Galster ◽

Stephen Johnson ◽

Bryan Bledsoe ◽

...

Keyword(s):

Success Rate ◽

Endotracheal Intubation ◽

Direct Laryngoscopy ◽

Intubation Attempt ◽

Spinal Immobilization ◽

Significant Difference ◽

Intubation Success ◽

First Pass ◽

Intubation Success Rate ◽

Cadaveric Model

AbstractObjectiveThe primary goal of this study was to compare paramedic first pass success rate between two different video laryngoscopes and direct laryngoscopy (DL) under simulated prehospital conditions in a cadaveric model.MethodsThis was a non-randomized, group-controlled trial in which five non-embalmed, non-frozen cadavers were intubated under prehospital spinal immobilization conditions using DL and with both the GlideScope Ranger (GL; Verathon Inc, Bothell, Washington USA) and the VividTrac VT-A100 (VT; Vivid Medical, Palo Alto, California USA). Participants had to intubate each cadaver with each of the three devices (DL, GL, or VT) in a randomly assigned order. Paramedics were given 31 seconds for an intubation attempt and a maximum of three attempts per device to successfully intubate each cadaver. Confirmation of successful endotracheal intubation (ETI) was confirmed by one of the six on-site physicians.ResultsSuccessful ETI within three attempts across all devices occurred 99.5% of the time overall and individually 98.5% of the time for VT, 100.0% of the time for GL, and 100.0% of the time for DL. First pass success overall was 64.4%. Individually, first pass success was 60.0% for VT, 68.8% for GL, and 64.5% for DL. A chi-square test revealed no statistically significant difference amongst the three devices for first pass success rates (P=.583). Average time to successful intubation was 42.2 seconds for VT, 38.0 seconds for GL, and 33.7 for seconds for DL. The average number of intubation attempts for each device were as follows: 1.48 for VT, 1.40 for GL, and 1.42 for DL.ConclusionThe was no statistically significant difference in first pass or overall successful ETI rates between DL and video laryngoscopy (VL) with either the GL or VT (adult).HodnickR, ZitekT, GalsterK, JohnsonS, BledsoeB, EbbsD. A comparison of paramedic first pass endotracheal intubation success rate of the VividTrac VT-A 100, GlideScope Ranger, and direct laryngoscopy under simulated prehospital cervical spinal immobilization conditions in a cadaveric model. Prehosp Disaster Med. 2017;32(6):621–624.

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Effect of Rocuronium vs Succinylcholine on Endotracheal Intubation Success Rate Among Patients Undergoing Out-of-Hospital Rapid Sequence Intubation: A Randomized Clinical Trial

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2020.03.003 ◽

2020 ◽

Vol 58 (3) ◽

pp. 548

Author(s):

Bethany Dalby ◽

Jerrilyn Jones

Keyword(s):

Clinical Trial ◽

Success Rate ◽

Randomized Clinical Trial ◽

Endotracheal Intubation ◽

Rapid Sequence Intubation ◽

Rapid Sequence ◽

Intubation Success ◽

Intubation Success Rate

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Comparison of Different Intubation Methods in Difficult Airways during Simulated Cardiopulmonary Resuscitation with Continuous Chest Compression: A Randomized Cross-Over Manikin Trial

Emergency Medicine International ◽

10.1155/2019/7306204 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7

Author(s):

Togay Evrin ◽

Jacek Smereka ◽

Damian Gorczyca ◽

Szymon Bialka ◽

Jerzy Robert Ladny ◽

...

Keyword(s):

Cardiopulmonary Resuscitation ◽

Airway Management ◽

Success Rate ◽

Endotracheal Intubation ◽

Chest Compression ◽

Macintosh Laryngoscope ◽

Intubation Time ◽

Intubation Success ◽

Intubation Success Rate ◽

Difficult Airways

Introduction. Airway management is one of key elements of resuscitation. Endotracheal intubation is still considered the gold standard for airway management during resuscitation. Aim. The aim of the study was to compare success rates and intubation time of different endotracheal intubation methods during emergency intubation with difficult airways in the conditions of cardiopulmonary resuscitation in a standardized manikin model. Methods. The study was designed as a prospective, randomized, cross-over simulation study. It involved 46 paramedics with at least 5 years of experience in Emergency Medical Service. The participants performed endotracheal intubation under difficult airway conditions during continuous chest compression, implemented with the LUCAS3 chest compression system. Three methods of tracheal intubation were applied: (1) standard Macintosh laryngoscope without a bougie stylet; (2) standard laryngoscope and a standard bougie stylet; (3) standard laryngoscope and a new bougie stylet. Results. The overall intubation success rate was 100% in the standard bougie and new bougie groups and lower (86.9%) when no bougie stylet was used (P=0.028). The intubation success rate with the 1st attempt equalled 91.3% for the new bougie group, 73.9% for standard bougie, and only 23.9% in the no-bougie group. The median intubation time was shortest in the new bougie group, where it amounted to 29 s (interquartile range [IQR]: 25–38); the time equalled 38s (IQR:31–44.5) in the standard bougie group and 47.5s (IQR:36–58) in the no-bougie group. The ease of use was lowest in the no-bougie group (85, IQR:63–88), average in the standard bougie group (44, IQR:30–51), and highest in the new bougie stylet group (32, IQR:19–41). Conclusion. In this manikin-based study, paramedics were able to perform endotracheal intubation with higher efficacy and in a shorter time using the new bougie stylet as compared with the standard bougie stylet.

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First-Attempt Endotracheal Intubation Success Rate Using A Telescoping Steel Bougie

Southwest Journal of Pulmonary and Critical Care ◽

10.13175/swjpcc004-21 ◽

2021 ◽

Vol 22 (1) ◽

pp. 36-40

Author(s):

Evan Schmitz ◽

Keyword(s):

Success Rate ◽

Critically Ill ◽

Endotracheal Intubation ◽

Critically Ill Patients ◽

Case Series ◽

Lehane Grade ◽

Intubation Success ◽

Intubation Success Rate ◽

Single Use ◽

Storage Methods

Background There has been a renewed interest in using the plastic intubation bougie to facilitate first-attempt endotracheal intubation success. The sterile single-use telescopic steel bougie (AIROD) was invented to overcome the limitations of the plastic bougie which is easily deformed during storage. Methods This is a retrospective study involving critically ill patients who were intubated with the AIROD in the intensive care unit at a single institution. The purpose of this case series is to compare the success rate of the AIROD to the generally accepted success rate for the traditional plastic bougie of 96%. Results A total of 54 patients were enrolled at a single ICU over a 10 months period. All patients were critically ill with 76% having a difficult airway, Cormack-Lehane grade view 2 or greater in 60%, and ARDS secondary to COVID-19 in 54%. The primary outcome of first-attempt intubation success in critically ill patients intubated in the ICU with the AIROD was 97% with a 95% confidence interval of 0.89 to 0.99. The average time for intubation of all airway classifications was 15 seconds. Conclusion The AIROD first-attempt intubation success rate was found to be similar to the rate for the traditional plastic bougie.

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Method for Teaching Life-Saving Combat First-Aid Skills With live–actor Patients Using a Wearable Training Apparatus

Military Medicine ◽

10.1093/milmed/usab286 ◽

2021 ◽

Author(s):

Minrui Lv ◽

Yijun Jia ◽

Zhaowen Zong ◽

Renqing Jiang ◽

Wenqiong Du ◽

...

Keyword(s):

Medical Students ◽

First Aid ◽

High Fidelity ◽

Simulation Methods ◽

Advantages And Disadvantages ◽

Life Saving ◽

Traditional Training ◽

Teaching Life ◽

Training Apparatus ◽

Medical Teachers

ABSTRACT Introduction Training combat personnel in combat first-aid skills has faced many challenges over time, such as the need to combine tactics with medicine and to overcome combat personnel’s lack of medical background knowledge. Therefore, many simulation methods are currently being developed, each of which has its advantages and disadvantages. In this study, a combined simulation method involving live–actor patients using a wearable training apparatus was developed, and the effects of this method were observed. Materials and Methods Focusing on the major causes of preventable deaths among victims killed in action, wearable training apparatuses simulating massive hemorrhage, airway obstruction, and tension pneumothorax were designed and produced. Methods of simulating these three injury types using live–actor patients with these training apparatuses were developed, and medical teachers evaluated the simulation effects. The live–actor patients were incorporated into a tactical scenario to train and test nonmedical and medical students in year 3, respectively. High-fidelity simulator-based training and traditional training without simulation served as the control. A post-training survey using a 7-point Likert scale evaluated the trainees’ feelings toward these training approaches. Results Three types of training apparatuses were developed to simulate three life-threatening injuries, and the simulation effects of the live–actor patients using these apparatuses were highly recognized by medical teachers. Both live–actor patients and high-fidelity simulator-based training improved performance significantly more than traditional training. However, the improvement due to training with live–actor patients was greater than that due to high-fidelity simulator-based training for nonmedical students, whereas there was no difference between these two simulation methods for medical students. A post-training survey revealed that all the trainees were confident in practicing first-aid skills after training, and they all agreed that live–actor patients could combine tactical situations with first aid better than high-fidelity simulators. The nonmedical students strongly agreed that live–actor patients were more helpful in the training of injury evaluation than high-fidelity simulators. Conclusions The method using wearable training apparatus-based live–actor patients was satisfying and effective for teaching life-saving combat first-aid skills, especially for nonmedical students.

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The Role of the Physician in a Helicopter Emergency Medical Service

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00026480 ◽

1990 ◽

Vol 5 (1) ◽

pp. 31-39 ◽

Cited By ~ 10

Author(s):

Robert J. Schwartz ◽

Lenworth M. Jacobs ◽

Margaret Lee

Keyword(s):

Success Rate ◽

Emergency Medical Service ◽

Endotracheal Intubation ◽

Medical Service ◽

Technical Skills ◽

Helicopter Emergency Medical Service ◽

Crew Member ◽

Physician Services ◽

Emergency Medical ◽

Intubation Success

AbstractThe purpose of this study was to measure the contributions of a physician crew member in a helicopter emergency medical service (HEMS) and to develop a method to utilize physician services more efficiently. A two-part study utilizing two independent sets of measurements of physician necessity was conducted. A post-flight questionnaire and the success rate for endotracheal intubation were used as measurement tools.With the passage of time, the fight nurses perceived the physician crew member' contribution to clinical judgment decreased from 21% to 1% of the flights and that the physician's contribution of technical skills (intubation) declined from 11% to 3%. The contribution to clinical decisions seemed more important on interhospital transports than on scene responses. The technical skills (judged by the tracheal intubation success rates) of a physician seemed more cogent on responses to the scene. When in the capacity of a second crew member with an experienced flight nurse, the endotracheal intubation success rate increased from 71% to 90%. Therefore, it seems that physician services could be restricted primarily to scene response flights. This limited utilization of flight physicians should make these physicians available for other duties.

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Comparison of Direct and Indirect Laryngoscopes in Vomitus and Hematemesis Settings: A Randomized Simulation Trial

BioMed Research International ◽

10.1155/2015/806243 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6 ◽

Cited By ~ 15

Author(s):

Ryosuke Mihara ◽

Nobuyasu Komasawa ◽

Sayuri Matsunami ◽

Toshiaki Minami

Keyword(s):

Tracheal Intubation ◽

Success Rate ◽

Macintosh Laryngoscope ◽

Intubation Time ◽

Direct Laryngoscope ◽

Mcgrath Mac ◽

Significant Difference ◽

Intubation Success ◽

Intubation Success Rate

Background.Videolaryngoscopes may not be useful in the presence of hematemesis or vomitus. We compared the utility of the Macintosh laryngoscope (McL), which is a direct laryngoscope, with that of the Pentax-AWS Airwayscope (AWS) and McGRATH MAC (McGRATH), which are videolaryngoscopes, in simulated hematemesis and vomitus settings.Methods.Seventeen anesthesiologists with more than 1 year of experience performed tracheal intubation on an adult manikin using McL, AWS, and McGRATH under normal, hematemesis, and vomitus simulations.Results.In the normal setting, the intubation success rate was 100% for all three laryngoscopes. In the hematemesis settings, the intubation success rate differed significantly among the three laryngoscopes (P=0.021). In the vomitus settings, all participants succeeded in tracheal intubation with McL or McGRATH, while five failed in the AWS trial with significant difference (P=0.003). The intubation time did not significantly differ in normal settings, while it was significantly longer in the AWS trial compared to McL or McGRATH trial in the hematemesis or vomitus settings (P<0.001, compared to McL or McGRATH in both settings).Conclusion.The performance of McGRATH and McL can be superior to that of AWS for tracheal intubation in vomitus and hematemesis settings in adults.

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