Cross-over study of novice intubators performing endotracheal intubation in an upright versus supine position

There are a number of potential physical advantages to performing orotracheal intubation in an upright position. The objective of this study was to measure the success of intubation of a simulated patient in an upright versus supine position by novice intubators after brief training. This was a cros...

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Bibliographic Details
Published in:Internal and emergency medicine 2017-06, Vol.12 (4), p.513-518
Main Authors: Turner, Joseph S., Ellender, Timothy J., Okonkwo, Enola R., Stepsis, Tyler M., Stevens, Andrew C., Eddy, Christopher S., Sembroski, Erik G., Perkins, Anthony J., Cooper, Dylan D.
Format: Article
Language:English
Subjects:
Clinical Competence - standards
Clinical Competence - statistics & numerical data
Cross-Over Studies
EM - Original
Emergency Medicine - education
Emergency Medicine - statistics & numerical data
Health Personnel - standards
Health Personnel - statistics & numerical data
Humans
Indiana
Internal Medicine
Intubation
Intubation, Intratracheal - methods
Intubation, Intratracheal - standards
Intubation, Intratracheal - statistics & numerical data
Laryngoscopy - methods
Laryngoscopy - standards
Laryngoscopy - statistics & numerical data
Logistic Models
Manikins
Mannequins
Medical students
Medicine
Medicine & Public Health
Patient Simulation
Physician assistants
Position measurement
Students
Students - statistics & numerical data
Supine Position
Time Factors
Trachea
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Summary:There are a number of potential physical advantages to performing orotracheal intubation in an upright position. The objective of this study was to measure the success of intubation of a simulated patient in an upright versus supine position by novice intubators after brief training. This was a cross-over design study in which learners (medical students, physician assistant students, and paramedic students) intubated mannequins in both a supine (head of the bed at 0°) and upright (head of bed elevated at 45°) position. The primary outcome of interest was successful intubation of the trachea. Secondary outcomes included log time to intubation, Cormack–Lehane view obtained, Percent of Glottic Opening score, provider assessment of difficulty, and overall provider satisfaction with the position. There were a total of 126 participants: 34 medical students, 84 physician assistant students, and 8 paramedic students. Successful tracheal intubation was achieved in 114 supine attempts (90.5 %) and 123 upright attempts (97.6 %; P  = 0.283). Upright positioning was associated with significantly faster log time to intubation, higher likelihood of achieving Grade I Cormack–Lehane view, higher Percent of Glottic Opening score, lower perceived difficulty, and higher provider satisfaction. A subset of 74 participants had no previous intubation training or experience. For these providers, there was a non-significant trend toward improved intubation success with upright positioning vs supine positioning (98.6 % vs. 87.8 %, P  = 0.283). For all secondary outcomes in this group, upright positioning significantly outperformed supine positioning.
ISSN:1828-0447
1970-9366
DOI:10.1007/s11739-016-1481-z