A Randomized Comparison of In-hospital Rescuer Positions for Endotracheal Intubation in a Difficult Airway

Area of Science:

• Emergency Medicine
• Medical Education
• Airway Management

Background:

• Emergency endotracheal intubation (ETI) is a critical procedure in emergency medicine.
• Rescuer position impacts ETI outcomes in prehospital settings, but in-hospital data is limited.
• Investigating rescuer position for in-hospital ETI may reveal obstacles to effectiveness.

Purpose of the Study:

• To compare the ETI performance of in-hospital emergency medicine trainees from seated versus standing positions.
• To determine if rescuer position affects ETI success rates and procedural difficulty.

Main Methods:

• Emergency medicine residents performed ETI on a difficult airway mannequin.
• Residents were randomized to perform ETI first from either a seated or standing position.
• Performance was scored using a modified checklist, with residents rating view and difficulty; data analyzed with paired t-tests.

Main Results:

• No statistically significant differences were found in ETI performance scores between seated and standing positions.
• Key metrics including number of attempts, time to success, and perceived difficulty were equivalent across positions.
• No differences in performance were observed across different levels of resident training.

Conclusions:

• Rescuer position (seated vs. standing) does not impact in-hospital ETI performance for EM trainees.
• Findings suggest potential value in training residents to perform ETI from both seated and standing positions.
• This adaptability may enhance ETI effectiveness in diverse environmental circumstances.