Abstract 157: Videographic Assessment of Pediatric Tracheal Intubation Technique
Background: Tracheal intubation (TI) is an uncommon procedure at the level of the individual provider in pediatric care. Published studies have examined optimal TI technique in adults; similar data is lacking in pediatrics. Our group previously published feasibility data examining simulated TI technique using video.
Objective: To examine technical aspects of pediatric TI using video recording and to determine the association between technique and outcomes.
Methods: Single center observational study. Resuscitations in our pediatric emergency department are video recorded as part of quality improvement. TI events under video recorded conditions were eligible for inclusion; TI performed by methods other than direct laryngoscopy were excluded. Videos were reviewed and scored using a published instrument assessing technical aspects of patient positioning, intubator kinematics, and equipment. Background data on intubators were collected. Outcome of interest was successful intubation; association between technical aspects and success were analyzed by χ2 testing.
Results: 44 pediatric TIs were reviewed. First attempt success was 57%; median number of attempts was 1 (range 1-6). Median laryngoscopy time was 34 s (range 8-142 s). Fellows had higher success rates (27/43, 63%) than residents (3/16, 19%) or attendings (9/19 (47%); p = 0.01). Technical aspects are summarized in Table 1. Higher success rates were observed with head elevation compared to supine positioning (18/28 (64%) vs. 19/45 (42%)) and lip retraction by an assistant (14/19 (74%) vs. 23/55 (41%)) but did not achieve statistical significance (p = 0.057 and 0.067).
Conclusion: In our data set, most pediatric TI attempts were made with the bed at the intubator’s waist, the patient’s head flat, the intubator bent > 45o at the waist, and with a less than 90o curve to the ET tube. Video review is feasible for assessing TI technique; additional data may clarify the association between technique and success.
Author Disclosures: Y. Shiima: None. J.R. Boulet: None. T. Hsieh: None. A. Donoghue: None.
- © 2014 by American Heart Association, Inc.