Via Research Recognition Day Program VCOM-Carolinas 2025

Clinical Educational Research

Evaluating the Effectiveness of Video Laryngoscopy vs Direct Laryngoscopy as a Training Tool for Pediatric Intubation Skills in Simulation Settings Natalie Markley, OMS-II; Tori Knapp, OMS-II; Elias Bouyounes, OMS-III; Saif Ghanayem, OMS-II; David Redden, PhD; Hanna S. Sahhar, MD, FAAP, FACOP Edward Via College of Osteopathic Medicine, Spartanburg, South Carolina

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Introduction

Results

Discussion

• Training medical students in pediatric endotracheal intubation is currently underdeveloped, with significant room for improvement. Neonatal intubation presents a high rate of adverse events, ranging from 18% to 60% (Miller, 2024). Additionally, O’Shea (2021) highlighted that success rates for neonatal intubation are notably low among junior trainees. These statistics underscore the urgent need for enhanced training methods. • Despite advancements in simulation technology and training methods in residency programs, the integration of these techniques during medical students' didactic years remains limited. This highlights a critical need to better incorporate simulation training into early medical education to address these gaps and improve outcomes. • The objective of this study is to evaluate and compare the effectiveness of video laryngoscopy (VL) versus direct laryngoscopy (DL) as training tools for medical students performing successful intubation on pediatric patients. The findings will guide recommendations on the most effective intubation training tool for medical schools. • Recruited 93 second-year medical students for the study. • The participants were split into two groups: Group A performed intubation on a pediatric simulation model using DL after being exposed to a tutorial video on DL intubation. Group B performed intubation on a pediatric simulation model using VL, ProVu Single-Use Video Laryngoscope, after being exposed to a tutorial video outlining VL intubation. • Upon successful intubation using their respective devices, the groups switched; Group A performed intubation using the VL after watching the VL tutorial, and Group B performed intubation using the DL after watching the DL tutorial. • The number of attempts to successfully perform endotracheal intubation and the time for successful endotracheal intubation were recorded. A maximum of five attempts are allowed by each subject and those unable to attempt successfully within these attempts are designated as unsuccessful intubations. • A pre-questionnaire was given to students prior to the study which assessed the skill level of the participants on intubation. A post questionnaire was given to assess the student’s perspective on VL vs DL as a training tool for second year medical students. Methods

49 students were assigned to sequence A, while 43 were assigned to sequence B. Tests of carry-over effects were not significant for time to intubation (p = 0.0766), number of attempts (p = 0.1281), and proportion failing (p = 0.3080). Given the lack of carry-over effects, we can test for outcome differences due to method. We observed that VL produced a statistically significant (p = 0.0024) lower intubation time (on average 37 seconds faster). We observed that VL averaged fewer attempts (on average 0.40 attempts fewer), though this difference did not quite achieve statistical significance (p = 0.0582). Finally, we observed a slightly lower proportion of failures for VL (3.6% fewer) though this was not statistically significant (p = 0.4603).

References • The goal of this study was to assess whether VL provides superior training outcomes for medical students when performing pediatric intubations compared to DL. • Post-questionnaires revealed 75% of the students found the VL to be highly effective in identifying landmarks for successful intubation. Additionally, 64% of the students agreed or strongly agreed that VL would serve as an effective teaching tool compared to the DL. This highlights the VL’s potential as a valuable resource in enhancing intubation training in medical education. • The VL displayed a faster time to intubate compared to the DL. Although not found to be statistically significant, the VL showed fewer attempts on average, and its p-value indicated there may be a closer correlation present. These results suggest that VL may offer valuable potential as a more efficient training tool for pediatric intubation. • Limitations: The sample size may have affected the statistical significance of the values that show VL technique is superior when compared to the DL. Only one brand video laryngoscope device was used for this study. Conclusions Insufficient training in pediatric intubation, particularly in identifying anatomical landmarks and mastering correct techniques, may contribute to the high rate of adverse effects in real life pediatric intubation rates. This study shows the importance of providing medical students with accurate, hands-on training in pediatric intubation. The VL has the potential to significantly enhance the students’ understanding of key anatomical landmarks and proper intubation techniques. Additionally, the VL may improve students’ performance with the DL by familiarizing them with critical aspects they need to perform a successful intubation. Further research needs to be done to fully support or challenge the hypothesis that teaching with the VL will improve intubation success rates. 1. Messina, S., Merola, F., Santonocito, C., Sanfilippo, M., Sanfilippo, G., Lombardo, F., Bruni, A., Garofalo, E., Murabito, P., & Sanfilippo, F. (2024). Articulating Video Stylet Compared to Other Techniques for Endotracheal Intubation in Normal Airways: A Simulation Study in Consultants with No Prior Experience. Journal of clinical medicine , 13 (3), 728. https://doi.org/10.3390/jcm13030728 2. Lee, J.H., Turner, D.A., Kamat, P. et al. The number of tracheal intubation attempts matters! A prospective multi-institutional pediatric observational study. BMC Pediatr 16, 58 (2016). https://doi.org/10.1186/s12887-016-0593-y 3. Kluj P, Fedorczak A, Fedorczak M, Gaszyński T, Kułak C, Wasilewski M, Znyk M, Bartczak M, Ratajczyk P. Comparison of Three Video Laryngoscopes and Direct Laryngoscopy for Emergency Endotracheal Intubation While Wearing PPE-AGP: A Randomized, Crossover, Simulation Trial. Healthcare . 2023; 11(6):884. https://doi.org/10.3390/healthcare11060884 4. Couto TB, Reis AG, Farhat SCL, Carvalho VEL, Schvartsman C. Changing the view: impact of simulation-based mastery learning in pediatric tracheal intubation with videolaryngoscopy. J Pediatr (Rio J). 2021;97(1):30-36. doi:10.1016/j.jped.2019.12.007 5. Cortese, G., Gassino, L., Micheletto, S., Sorbello, M., Cataldo, R., Brazzi, L. (2024, April). Feasibility of ProVu Video Stylet for awake intubation of patients with severe obesity: A pilot observational study. Trends in Anaesthesia and Critical Care , 55. https://doi.org/https://doi.org/10.1016/j.tacc.2024.101339 6. Nikolla, D. A., Boulet, S., & Carlson, J. N. (2023). Comparison of Rigid and Articulating Video Stylets During Simulated Endotracheal Intubation With Hyperangulated Video Laryngoscopy. The Journal of emergency medicine , 64(3), 315 – 320. https://doi.org/10.1016/j.jemermed.2023.01.007 7. Brown W, Santhosh L, Brady AK, Denson JL, Niroula A, Pugh ME, Self WH, Joffe AM, O'Neal Maynord P, Carlos WG. A call for collaboration and consensus on training for endotracheal intubation in the medical intensive care unit. Crit Care. 2020 Oct 22;24(1):621. doi: 10.1186/s13054-020-03317-3 8. O’Shea, J. E., Edwards, G., Kirolos, S., Godden, C., & Brunton, A. (2021). Implementation of a standardized neonatal intubation training package. The Journal of Pediatrics , 236. https://doi.org/10.1016/j.jpeds.2021.04.056 We would like to thank the VCOM-CC Simulation Department, Dr. Rishmawi, Dr. Worster, and Dr. Lindsey for their help in contributing to this project. IRB Reviewal Committee: Edward Via College of Osteopathic Medicine Institutional Review Board, Blacksburg, VA IRB Protocol Number: 2024-209 IRB Approval Date: February 14th, 2025 Acknowledgements

Table 1. Tests for Difference Between Methods

Mean Difference between VL and DL

95% Confidence Interval

Outcomes

p-value

36.5

(-59.70, -13.30)

0.0024

Time (seconds)

-0.4

(-0.81, 0.01)

0.0582

Attempts

-3.60%

(-13.40%, 6.11%)

0.4603

Proportion Failing

Figure 2. Boxplots for Time to Intubation by Sequence and Method. Sequence A shows the Group A starting with DL then switching to VL. Sequence B shows Group B starting with VL then switching to DL.

2025 Research Recognition Day

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