Eye-tracking during simulated endotracheal newborn intubation: a prospective, observational multi-center study

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.