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Related Experiment Videos

Laryngoscopic intubation: learning and performance.

Julian T Mulcaster1, Joanna Mills, Orlando R Hung

  • 1Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada.

Anesthesiology
|December 28, 2002
PubMed
Summary
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Competent direct laryngoscopic tracheal intubation (LEI) requires significant training. Statistical modeling suggests 47 attempts are needed for a 90% success rate, highlighting the inadequacy of manikin-only training for nonanesthesia personnel.

Area of Science:

  • Medical Education
  • Anesthesiology
  • Emergency Medicine

Background:

  • Direct laryngoscopic tracheal intubation (LEI) is a critical, potentially life-saving procedure for healthcare professionals.
  • Defining competence and the required number of successful exposures for LEI training is essential.
  • Current training methods may not adequately prepare nonanesthesia personnel for LEI.

Purpose of the Study:

  • To determine the number of successful direct laryngoscopic tracheal intubation (LEI) exposures needed for competent performance.
  • To define the criteria for competence in LEI.
  • To evaluate the effectiveness of current LEI training for nonanesthesia personnel.

Main Methods:

  • Longitudinal study of 20 nonanesthesia trainees performing 438 LEIs in operating room settings.

Related Experiment Videos

  • Observation and videotape analysis of trainee performance, with 18 LEIs by experienced anesthesiologists establishing a performance standard.
  • Generalized linear, mixed-modelling approach to estimate the number of intubations required for expertise.

    • Main Results:

    • Trainees performed 18-35 intubations, but statistical modeling indicated 47 attempts for a 90% probability of a "good intubation".
    • Proper laryngoscope insertion and lifting were identified as critical for competent LEI performance.
    • Traditional factors like head and neck positioning were less critical under study conditions.

    Conclusions:

    • Manikin-only training is insufficient for teaching direct laryngoscopic tracheal intubation (LEI) to nonanesthesia personnel.
    • Current standards for LEI teaching require reevaluation for nonanesthesia healthcare providers.
    • Enhanced training protocols are necessary to ensure LEI competence.