A Simulation Study examining the Efficacy of Videolaryngoscopy in infants, children, and adolescents with Trisomy 21
The Difficult Pediatric Airway: A Simulation Study Examining the Efficacy of Videolaryngoscopy inInfants, Children and Adolescents with Trisomy 21 James Burhop DO, MS PEM Fellow – CHKD/EVMS Dr.Burhop@gmail.com Mentor: Joel Clingenpeel MD, MPH
Hypothesis Videolaryngoscopy provides an advantageleading to successful intubation of a difficultpediatric airway when compared with direct laryngoscopy.
Goals & Objectives Assess if pediatric emergency physicians can successfully intubate and secure a difficultpediatric airway with improved rates of tracheal intubation using videolaryngoscopy whencompared with direct laryngoscopy in a manikin with atlantoaxial instability and macroglossia.
RationaleOur study looks to enhance safety and improvepatient outcome through simulation of difficultpediatric airway scenarios with an emphasis on laryngoscopic technology, curriculum development and education.
Background• It has been established that the videolaryngoscope is a valuable tool in securing the successful tracheal intubation of difficult airways in adult patients.• There is minimal available evidence to gauge its efficacy within the infant, child and adolescent populations.• Literature is virtually devoid of simulation studies in individuals with specific syndromes such as trisomy 21.• Clinical encounters involving pediatric intubation are uncommon when compared with adults, which highlights the importance of developing realistic airway simulation scenarios that create opportunities for practice with video and direct laryngoscopes.
Methodology• Performance features of direct laryngoscopy with Macintosh blades are compared with videolaryngoscopy using the Storz CMAC scope.• Cross-sectional and performed within a large tertiary children’s hospital simulation center.• Study participants are pediatric emergency medicine physicians with fellowship training and difficult airway experience.• Difficult pediatric airways are simulated with macroglossia, atlantoaxial instability and neck immobilization.• Study participants will view a pre-scenario videolaryngoscopy training video that is unique to the specific simulation equipment available in our simulation laboratory.• Each study participant performs intubation during a difficult airway scenario on an infant, child and adolescent manikin.• The time to successful tracheal intubation is recorded along with prevalence of first-attempt tracheal intubation using direct laryngoscopy as compared to videolaryngoscopy.
References• 1. Hung, C. K. A comparison of the Trachway intubating stylet and the Macintosh laryngoscope in tracheal intubation: a manikin study. Journal of Anesthesia 2012; 26, 1491-6• 2. Donoghue, A. J. Videolaryngoscopy Versus Direct Laryngoscopy in Simulated Pediatric Intubation. Annals of Emergency Medicine 2012; 12, 1532-6• 3. Healy, D. W. Comparison of the glidescope, CMAC, storz DCI with the Macintosh laryngoscope during simulated difficult laryngoscopy: a manikin study. BMJ Anesthesiology 2012; 12, 11