Procedural Training in Acute Care: A Prospective Study of Learning Intubation Highlighting a Novel Method

The researchers compared average intubation times between four different devices and hypothesized that a novel laryngoscope based on an enhancement of the rigid anterior commissure laryngoscope would produce faster times to intubation compared to a Macintosh blade with a bougie among inexperienced users on the difficult airway simulation.

Participants were stratified into novice, intermediate, and advanced skill levels. Each group first performed intubation on a manikin airway without modifications ("easy" airway)-using each of four devices (novel laryngoscope, Macintosh alone, Macintosh with bougie, and GlideScope) in random order-followed by the same technique on a manikin with modifications to mimic a "difficult" airway. Devices requiring the use of a bougie utilize a Seldinger technique. The primary outcome measure was the time taken to inflate the manikin's lungs with the bag ventilator.

Ninety-eight participants were recruited and grouped according to their self-reported experience level: 41 novices, 39 intermediate, and 18 experts. The novel laryngoscope with gum elastic bougie (GEB) led to quicker intubation times (mean 32.0 s) compared with the Macintosh with GEB (mean 37.5 s) among the novice and intermediate groups on the difficult airway (p < 0.05). The methods that utilized a bougie (Macintosh blade with a GEB and Novel Laryngoscope with GEB) led to slower intubation times than the methods not utilizing a bougie (Macintosh blade and GlideScope).

In summary, the Seldinger technique is an important skill for those who perform endotracheal intubations (ETIs), even infrequently or in nonideal settings. The novel laryngoscope may be a helpful option to attain ETI with the reliability of the Seldinger technique and a consistently short ETI interval.