Scottish Paediatric Anaesthetic Network April Scottish Paediatric Anaesthetic Network April 2008 2008

The Berci Kaplan video-The Berci Kaplan video-laryngoscope increases laryngoscope increases

paediatric tracheal paediatric tracheal intubation success by intubation success by

non-anaesthetistsnon-anaesthetists

L. Walker, G. Wilson, T.Engelhardt, J.MorseL. Walker, G. Wilson, T.Engelhardt, J.Morse

Dept of Anaesthesia, Royal Aberdeen Childrens HospitalDept of Anaesthesia, Royal Aberdeen Childrens Hospital

BackgroundBackground

Paediatric tracheal Paediatric tracheal intubation is a vital intubation is a vital and life saving skill and life saving skill in the emergent in the emergent settingsetting

BackgroundBackground

Tracheal intubation is a core skill in Tracheal intubation is a core skill in anaesthesia anaesthesia

Paediatric airway provides particular Paediatric airway provides particular challenges to both to acquisition and challenges to both to acquisition and teaching of this skillteaching of this skill

Video-LaryngoscopyVideo-Laryngoscopy

Provides a view of airway anatomy Provides a view of airway anatomy which is not dependant on which is not dependant on laryngoscopists direct line of sightlaryngoscopists direct line of sight

Berci Kaplan video-laryngoscope Berci Kaplan video-laryngoscope projects image from tip of blade onto projects image from tip of blade onto a screen remote from patienta screen remote from patient

Berci Kaplan video-laryngoscopeBerci Kaplan video-laryngoscope

Video-LaryngoscopyVideo-Laryngoscopy

AdvantagesAdvantagesIncreases angle of view from 15Increases angle of view from 1500 to 80to 8000

Shared point of view for teacher and Shared point of view for teacher and learnerlearner

Similar design and technique to Similar design and technique to Macintosh laryngoscopeMacintosh laryngoscope

Video-LaryngoscopyVideo-Laryngoscopy

DisadvantagesDisadvantages

Need for coordination between hand Need for coordination between hand movements and screenmovements and screen

Angle of view, direct vs. video-Angle of view, direct vs. video-laryngoscopylaryngoscopy

Video-LaryngoscopyVideo-Laryngoscopy Berci Kaplan video-laryngoscope has been Berci Kaplan video-laryngoscope has been

studied both for airway management and as a studied both for airway management and as a teaching toolteaching tool

Has been shown to be of use in management of Has been shown to be of use in management of difficult airways difficult airways

Greater incidence of successful tracheal Greater incidence of successful tracheal intubation by novice practitioners in adult settingintubation by novice practitioners in adult setting

Low D. Healy D. Rasburn N. The use of the BERCI DCI Video Laryngoscope for Low D. Healy D. Rasburn N. The use of the BERCI DCI Video Laryngoscope for teaching novices direct laryngoscopy and tracheal intubation. teaching novices direct laryngoscopy and tracheal intubation. Anaesthesia. Anaesthesia. 63(2):195-201, 2008 Feb.63(2):195-201, 2008 Feb.

Berci Kaplan video-laryngoscopeBerci Kaplan video-laryngoscope

HypothesisHypothesis

We hypothesised that the familiar We hypothesised that the familiar design and intuitive technique of design and intuitive technique of video-laryngoscopy would result in a video-laryngoscopy would result in a shorter time to visualise the glottis shorter time to visualise the glottis and intubate the trachea, with a and intubate the trachea, with a higher rate of success for novices in higher rate of success for novices in the paediatric settingthe paediatric setting

MethodsMethods

Research Ethics Committee approvalResearch Ethics Committee approval

70 non-anaesthesia staff recruited 70 non-anaesthesia staff recruited (nursing staff, theatre ODPs, medical (nursing staff, theatre ODPs, medical students, non-anaesthesia medical students, non-anaesthesia medical trainees)trainees)

Any previous tracheal intubation Any previous tracheal intubation experience recordedexperience recorded

MethodsMethods

Given baseline training in Given baseline training in laryngoscopy and intubation with laryngoscopy and intubation with direct and video-laryngoscopes direct and video-laryngoscopes

Standardised description and Standardised description and practical demonstrationpractical demonstration

MethodsMethods

MethodsMethods

Laerdal SimBaby manikin usedLaerdal SimBaby manikin used Realistic, airway anatomyRealistic, airway anatomy Reproducible environment Reproducible environment

MethodsMethods

Volunteers asked to view the glottis Volunteers asked to view the glottis of manikin and if possible, intubate of manikin and if possible, intubate using both direct and video-using both direct and video-laryngoscopes, in a random orderlaryngoscopes, in a random order

Time to view glottis, time to Time to view glottis, time to intubation and placement of tube intubation and placement of tube recordedrecorded

MethodsMethods

Results Results

Time to view glottisTime to view glottis

Direct Laryngoscopy 11.5 secondsDirect Laryngoscopy 11.5 seconds

(Range of 2-78 seconds)(Range of 2-78 seconds)

Video-Laryngoscopy 8 secondsVideo-Laryngoscopy 8 seconds

(Range of 1-48 seconds)(Range of 1-48 seconds)

Results Results

Success of intubationSuccess of intubation

Direct Laryngoscopy 53%Direct Laryngoscopy 53%

Video-Laryngoscopy 84%Video-Laryngoscopy 84%

ResultsResults

Time to intubationTime to intubation

Direct Laryngoscopy 40.5 secondsDirect Laryngoscopy 40.5 seconds

(Range of 8-100 seconds)(Range of 8-100 seconds)

Video-Laryngoscopy 34.5 secondsVideo-Laryngoscopy 34.5 seconds

(Range of 8-104 seconds)(Range of 8-104 seconds)

ResultsResults

43/70 volunteers stated that the video-43/70 volunteers stated that the video-laryngoscopy was easier to use, stating laryngoscopy was easier to use, stating factors such as improved view of glottis factors such as improved view of glottis and greater certainty of tube positionand greater certainty of tube position

6/70 volunteers commented on 6/70 volunteers commented on difficulties coordinating hand and difficulties coordinating hand and screen movements during video-screen movements during video-laryngoscopylaryngoscopy

DiscussionDiscussion

Marked increase in incidence of Marked increase in incidence of successful tracheal intubation by successful tracheal intubation by novices using video-laryngoscopy novices using video-laryngoscopy

Straightforward to teach and critiqueStraightforward to teach and critique

DiscussionDiscussion

Potential uses of video-laryngoscopyPotential uses of video-laryngoscopy

-Teaching paediatric airway skills-Teaching paediatric airway skills

-Use by personnel with little -Use by personnel with little paediatric intubation experience paediatric intubation experience in emergency setting in emergency setting