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Eye-tracking during simulated endotracheal newborn intubation: a prospective, observational multi-center study
Lisa Kessler1,2,3,4,5, Peter Gröpel6, Heidi Aichner7,8
1Department of Pediatrics, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria. lisa.kessler@meduniwien.ac.at.
Insights
Health care providers' visual attention during simulated neonatal intubation varied with experience and intubation type. While experience improved focus, it did not significantly enhance intubation success rates.
Area of Science:
- Medical simulation
- Neonatal resuscitation
- Ophthalmology
Background:
- Neonatal intubation is a critical procedure.
- Assessing health care providers' (HCPs) performance is essential.
- Visual attention (VA) during procedures is not fully understood.
Purpose of the Study:
- To evaluate HCPs' VA during simulated neonatal intubation using eye-tracking technology.
- To identify factors influencing VA and intubation performance.
Main Methods:
- Eye-tracking glasses (Tobii Pro Glasses 2) were used to record VA in 30 HCPs.
- Participants performed simulated neonatal intubation (orotracheal and nasotracheal).
- Intubation duration, success rate, and VA were measured and compared based on experience and intubation type.
Main Results:
- 50% of intubations exceeded the 30-second recommended time.
- Nasotracheal intubations frequently exceeded the time limit.
- VA differed significantly between experienced and less experienced HCPs, and between orotracheal and nasotracheal intubations.
- Increased experience correlated with higher situational awareness and fewer distractions, but not significantly better performance.
Conclusions:
- Neonatal intubation duration varies by approach (orotracheal vs. nasotracheal).
- HCPs' VA is influenced by experience, intubation type, and duration.
- Intubator experience is crucial for reducing intubation time and improving focus on relevant stimuli.
Background:
The aim was to assess health care providers' (HCPs) visual attention (VA) by using eye-tracking glasses during a simulated neonatal intubation.
Methods:
HCPs from three pediatric and neonatal departments (Feldkirch and Vienna, Austria, and Edmonton, Canada) completed a simulated neonatal intubation scenario while wearing eye-tracking glasses (Tobii Pro Glasses 2®, Tobii, Stockholm, Sweden) to record their VA. Main outcomes included duration of intubation, success rate, and VA. We further compared orotracheal and nasotracheal intubations.
Results:
30 participants were included. 50% completed the intubation within 30 s (M = 35.40, SD = 16.01). Mostly nasotracheal intubations exceeded the limit. Experience was an important factor in reducing intubation time. VA differed between more and less experienced HCPs as well as between orotracheal and nasotracheal intubations. Participants also focused on different areas of interest (AOIs) depending on the intubator's experience. More experience was associated with a higher situational awareness (SA) and fewer distractions, which, however, did not transfer to significantly better intubation performance.
Conclusion:
Half of the intubations exceeded the recommended time limit. Differences in intubation duration depending on type of intubation were revealed. VA differed between HCPs with different levels of experience and depended on duration and type of intubation.
Impact:
Simulated neonatal intubation duration differs between orotracheal and nasotracheal intubation. Visual attention during simulated neonatal intubation shows differences depending on intubation duration, intubator experience, type of intubation, and level of distraction. Intubator experience is a vital parameter for reducing intubation duration and improving intubator focus on task-relevant stimuli.
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