Video laryngoscopy leads to more successful first attempt intubations in neonates
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Key takeaways:
- Doctors in training vs. neonatologists were behind most of the intubation attempts.
- The proportion of successful first attempts was higher with video vs. direct laryngoscopy across several subgroups.
SAN DIEGO — Clinicians using video vs. direct laryngoscopy for urgent intubation in neonates had more successful first attempts, according to a presentation at the American Thoracic Society International Conference.
“Among neonates undergoing urgent endotracheal intubation, video laryngoscopy resulted in a greater number of successful intubations on the first attempt than direct laryngoscopy,” Colm P. F. O’Donnell, MB, PhD, consultant neonatologist at National Maternity Hospital in Dublin, Ireland, said during his presentation.
As Healio previously reported, in a multicenter, unblinded, randomized parallel group trial (DEVICE), clinicians who used video vs. direct laryngoscopes for emergency tracheal intubation in adults had higher rates of successful first attempts.
O’Donnell and colleagues assessed 214 neonates without anomalies who required urgent intubation in a single center trial to find out if indirect video laryngoscopy led to more successful intubations in one attempt (via exhaled carbon dioxide detector) than direct laryngoscopy.
Of the total cohort, 107 neonates (68% born before 32 weeks’ gestation; 42% less than 1,000 g at birth) underwent video laryngoscopy, and the remaining 107 (66% born before 32 weeks’ gestation; 42% less than 1,000 g at birth) underwent direct laryngoscopy.
High proportions of neonates in both groups received medication before the procedure (video, 63%; direct, 75%) and underwent the procedure within 24 hours after being born (video, 86% vs. direct, 78.5%).
Intubation more commonly occurred in the NICU vs. the delivery room (71% vs. 29%), and O’Donnell highlighted that most of the clinicians who made the attempt were doctors in training in pediatrics/neonatology vs. neonatologists (video, 92% vs. 8%; direct, 97% vs. 3%).
Between the two groups, researchers observed significantly more successful first attempts among those who received video vs. direct laryngoscopy (74% vs. 45%; P < .001).
“The median number of attempts taken to achieve successful intubation was one in the video group and two in the direct laryngoscopy group,” O’Donnell said.
Researchers continued to find a greater proportion of successful first intubation attempts in the video vs. direct laryngoscopy group across four subgroups:
- less than 32 weeks’ gestational age (73% vs. 34%);
- less than 1,000 g at birth (71% vs. 29%);
- delivery room procedure (63% vs. 36%); and
- NICU procedure (80% vs. 48%).
Among those who underwent video laryngoscopy, the median lowest oxygen saturation reached during intubation was higher than that of those who underwent direct laryngoscopy (74% vs. 68%), as was the median lowest heart rate during the procedure (153 beats/minute vs. 148 beats/minute).
During his presentation, O’Donnell noted small proportions of neonates in each group who experienced oral trauma (video, 0% vs. direct, 1%) or had to receive chest compressions (video, 6% vs. direct, 5%) or epinephrine (video, 3% vs. direct, 1%).
Intubation was not related to the three reported deaths that took place, according to researchers.
“Our trial was not adequately powered to detect effects on adverse outcomes,” O’Donnell and colleagues wrote in the published study. “Future studies should be large enough to determine whether video laryngoscopy has the potential to reduce harm.”