Real-Time Intubation and Ventilation Feedback: A Randomized Controlled Simulation Study

In this randomized controlled simulation-based trial at Medical University of Vienna a total of 167 medical students executed ventilation and intubation maneuvers on a newborn manikin. The study aimed to determine the best educational application of a respiratory function monitor (RFM) and a video laryngoscope (VL).  

Respiratory parameters were recorded with a RFM (Neo Training, Monivent AB) and for intubations a video laryngoscope (InfantView, Acutronic Medical AG) was utilized. The primary outcome for ventilation quality was the percentage of ventilations with expiratory tidal volumes (pVTe) within a target range of 4 to 8mL/kg for each participant and each group. For intubation, primary outcome was the number of attempts until success. The secondary outcomes were mask leak, PIP, ventilation rate, time to intubation and demographic data. 

Participants were randomized into 3 groups with different visibility of the feedback devices. Uniformly trained supervisors were present in all groups to provide a homogenous supervision experience. Group A, the “non-access group”, had no visual access to the feedback devices. In group B, the “supervisor- access group”, only the supervisor had access to the feedback monitors, and in group C, which was the “full-access group”, both supervisor and participant could see feedback information displayed on monitors. 

The authors reported the group C, “full-access group” to have highest percentage of ventilations within the tidal volume range (full-access 63.6%, supervisor-access 51.0%, no-access 31.1%, P<.001) and the lowest mask leakage (full-access 34.9%, supervisor-access 46.6%, no-access 61.6%; A to B: P<.001, A to C: P<.001, A to C: P<.003). Overall, the “full-access group” achieved superior ventilation quality regarding primary and secondary outcome measures as well as having the lowest number of intubation attempts until success. 

Conclusion

The authors conclude that their findings confirm that the visual access to feedback devices for supervisors and trainees alike considerably benefits outcomes and can contribute to the future of clinical education.