This study investigates whether laryngoscope motion-tracking technology can be used to differentiate expert versus novice providers' techniques during endotracheal intubation in infant manikins; this may help improve intubation techniques.
Each of 11 experts and 11 novices intubated an infant manikin head (Laerdal Corp, Wappinger Falls, NY) 10 times. Laryngoscope motion was tracked using electromagnetic technology during: (1) time from acquisition of laryngoscope to oral insertion, (2) insertion to stabilization of laryngoscope, and (3) stabilization of laryngoscope to insertion of endotracheal tube and withdrawal of laryngoscope. There were 213/220 analyzable data files. Expert versus novice rate of success, laryngoscope blade-tip motion path length, handle angle at intubation, time in each phase, and motion of handle relative to manikin were compared.
Intubation success rate was greater for experts (105/105 = 100% vs novices 101/108 = 93.5%, P < 0.001). Expert path of motion in phase 2 was longer (mean, 39 vs 29 cm, P < 0.001). The mean difference in the laryngoscope handle angle relative to the manikin occiput was statistically significant (mean angle, -54.42 vs -56.63 degrees; P = 0.001) but within the equipment testing margin of error (2 degrees). Time from insertion to withdrawal of laryngoscope (phases 2 and 3 combined) was greater for experts (16.45 vs 13.15 seconds; P = 0.02). Both experts and novices "rocked" the laryngoscope to achieve laryngeal visualization.
It is feasible to track laryngoscope motion during manikin intubation comparing expert versus novice technique. Experts had a greater success rate, but longer path length, and took longer to achieve manikin intubation. Motion-tracking technology may provide an analytic tool to improve techniques of intubation.
"Our experiments involved three subjects with different levels of experiences in ETI – one experienced (attending physician), one intermediate (resident in Emergency Medicine) and one novice provider (with no previous ETI experience; went through a quick training session prior to the experiments ). Each performed four ETI attempts on a dummy. "
[Show abstract][Hide abstract] ABSTRACT: Endotracheal intubation (ETI) is a crucial medical procedure per-formed on critically ill patients. It involves insertion of a breathing tube into the trachea i.e. the windpipe connecting the larynx and the lungs. Often, this procedure is performed by the paramedics (aka providers) under challenging prehospital settings e.g. roadside, am-bulances or helicopters. Successful intubations could be lifesaving, whereas, failed intubation could potentially be fatal. Under prehos-pital environments, ETI success rates among the paramedics are sur-prisingly low and this necessitates better training and performance evaluation of ETI skills. Currently, few objective metrics exist to quantify the differences in ETI techniques between providers. In this pilot study, we develop a quantitative framework for discrimi-nating the kinematic characteristics of providers with different ex-perience levels. The system utilizes statistical analysis on spatio-temporal multimodal features extracted from optical motion cap-ture, accelerometers and electromyography (EMG) sensors. Our experiments involved three individuals performing intubations on a dummy, each with different levels of training. Quantitative per-formance analysis on multimodal features revealed distinctive dif-ferences among different skill levels. In future work, the feedback from these analysis could potentially be harnessed for enhanced ETI training.
[Show abstract][Hide abstract] ABSTRACT: Success rates with emergent endotracheal intubation (ETI) improve with increasing provider experience. Few objective metrics exist to quantify differences in ETI technique between providers of various skill levels. We tested the feasibility of using motion capture videography to quantify variability in the motions of the left hand and the laryngoscope in providers with various experience.
Three providers with varying levels of experience [attending physician (experienced), emergency medicine resident (intermediate), and postdoctoral student with no previous ETI experience (novice)] each performed ETI 4 times on a mannequin. Vicon, a 16-camera system, tracked the 3-dimensional orientation and movement of markers on the providers, handle of the laryngoscope, and mannequin. Attempt duration, path length of the left hand, and the inclination of the plane of the laryngoscope handle (mean square angular deviation from vertical) were calculated for each laryngoscopy attempt. We compared interattempt and interprovider variability of each measure.
All ETI attempts were successful. Mean (SD) duration of laryngoscopy attempts differed between experienced [5.50 (0.68) seconds], intermediate [6.32 (1.13) seconds], and novice [12.38 (1.06) seconds] providers (P = 0.021). Mean path length of the left hand did not differ between providers (P = 0.37). Variability of the plane of the laryngoscope differed between providers: 8.3 (experienced), 28.7 (intermediate), and 54.5 (novice) degrees squared.
Motion analysis can detect interprovider differences in hand and laryngoscope movements during ETI, which may be related to provider experience. This technology has potential to objectively measure training and skill in ETI.
Simulation in healthcare: journal of the Society for Simulation in Healthcare 07/2012; 7(4):255-60. DOI:10.1097/SIH.0b013e318258975a · 1.48 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: As simulation is increasingly used to study questions pertaining to pediatrics, it is important that investigators use rigorous methods to conduct their research. In this article, we discuss several important aspects of conducting simulation-based research in pediatrics. First, we describe, from a pediatric perspective, the 2 main types of simulation-based research: (1) studies that assess the efficacy of simulation as a training methodology and (2) studies where simulation is used as an investigative methodology. We provide a framework to help structure research questions for each type of research and describe illustrative examples of published research in pediatrics using these 2 frameworks. Second, we highlight the benefits of simulation-based research and how these apply to pediatrics. Third, we describe simulation-specific confounding variables that serve as threats to the internal validity of simulation studies and offer strategies to mitigate these confounders. Finally, we discuss the various types of outcome measures available for simulation research and offer a list of validated pediatric assessment tools that can be used in future simulation-based studies.
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