Jennifer E Sainsbury1, Branislav Telgarsky1, Matteo Parotto1, Ahtsham Niazi2, David T Wong2, Richard M Cooper3. 1. Department of Anesthesia, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada. 2. Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada. 3. Department of Anesthesia, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada. richard.cooper@uhn.ca.
Abstract
PURPOSE: Skill acquisition in direct laryngoscopy (DL) and tracheal intubation is complex. This pilot study aims to assess feasibility and determine sample size for a subsequent trial comparing DL instruction using a Macintosh-style video laryngoscope (MacVL), with and without video recordings, with conventional DL instruction. METHODS:Medical students with no prior laryngoscopy experience were recruited during their two-week anesthesia rotation. During the first (TRAINING) week, students were randomized into three groups: Control (Macintosh direct laryngoscope), VL-1 (MacVL with real-time feedback), and VL-2 (MacVL with real-time feedback plus video recordings of laryngoscopies). During the second (TESTING) week, all students were tested using a Macintosh direct laryngoscope. Feasibility objectives were recruitment and attrition rates, ability to time and video record intubations, and the availability of a MacVL. The primary clinical outcome during the TESTING week was total time to intubate, and secondary outcomes included intubation success rate, intubating opportunities, complications, and confidence scores. RESULTS:Sixty-eight of 87 (78%) consecutive medical students approached to participate in the study were recruited over 18 months. Eight (12%) students withdrew from the study, and data are available on the remaining 60 participants. The times to intubate were recorded for 92% of the TESTING intubations, but only 71% of the TRAINING intubations in the VL-2 group were video recorded. The MacVLs were available in 100% of cases. We estimate that 190 participants would be required for a study restricted to a comparison ofDL vs video laryngoscopy with real-time feedback. CONCLUSION: This pilot study establishes feasibility and provides a sample size estimate for a future RCT. Required modifications to the study protocol include wider hospital involvement and consideration regarding standardization of airway education, teaching, feedback, and patient characteristics.
RCT Entities:
PURPOSE: Skill acquisition in direct laryngoscopy (DL) and tracheal intubation is complex. This pilot study aims to assess feasibility and determine sample size for a subsequent trial comparing DL instruction using a Macintosh-style video laryngoscope (MacVL), with and without video recordings, with conventional DL instruction. METHODS: Medical students with no prior laryngoscopy experience were recruited during their two-week anesthesia rotation. During the first (TRAINING) week, students were randomized into three groups: Control (Macintosh direct laryngoscope), VL-1 (MacVL with real-time feedback), and VL-2 (MacVL with real-time feedback plus video recordings of laryngoscopies). During the second (TESTING) week, all students were tested using a Macintosh direct laryngoscope. Feasibility objectives were recruitment and attrition rates, ability to time and video record intubations, and the availability of a MacVL. The primary clinical outcome during the TESTING week was total time to intubate, and secondary outcomes included intubation success rate, intubating opportunities, complications, and confidence scores. RESULTS: Sixty-eight of 87 (78%) consecutive medical students approached to participate in the study were recruited over 18 months. Eight (12%) students withdrew from the study, and data are available on the remaining 60 participants. The times to intubate were recorded for 92% of the TESTING intubations, but only 71% of the TRAINING intubations in the VL-2 group were video recorded. The MacVLs were available in 100% of cases. We estimate that 190 participants would be required for a study restricted to a comparison of DL vs video laryngoscopy with real-time feedback. CONCLUSION: This pilot study establishes feasibility and provides a sample size estimate for a future RCT. Required modifications to the study protocol include wider hospital involvement and consideration regarding standardization of airway education, teaching, feedback, and patient characteristics.