Trainer Feedback with C Mac Videolaryngoscope Screen Visible Only to Trainer does not Decrease Time to Endotracheal Intubation Compared to Conventional Laryngoscopy when Performed by Novice Anaesthesiologist Trainee: A Randomized Controlled Pilot Trial

Abstract

Introduction: A shared view of the glottis to both the trainer and the novice anaesthesia trainee (NAT) appears
ideal for teaching endotracheal intubation (ETI) with regards to decreased time to intubation, trainee-trainer
comfort and lesser patient morbidity. However, this is not possible in direct laryngoscopy. Video laryngoscope
(VL) may provide the solution. The present study hypothesised that the time to ETI would be lesser when a NAT
performs ETI with a VL with screen of VL visible only to the trainer due to real-time feedback.
Methods: First-semester anaesthesiology residents, with no previous ETI exposure were recruited and randomized
to two groups after teaching about ETI using a manual and video. Group A: ETI with DL with trainer verbal
feedback; Group B: ETI with VL with trainer verbal feedback, VL screen visible only to the trainer. The primary
outcome was time to ETI. Secondary outcomes were success rate, teeth trauma/clicks by the laryngoscope,
mucosal bleed, incidence of bougie use, trainee’s perception of difficulty and oesophageal intubations.
Results: A total of 190 intubations were performed, 95 in each group. The mean time taken from insertion of
laryngoscope blade to completion of ETI was not statistically significant (01:07 mins in group A vs 1:00 min in
group B; P=0.1). Second attempts were significantly more in Group B (P=0.002). None of the other secondary
outcomes reached statistical significance.
Conclusion: In NAT, trainer feedback via VL does not result in lesser time to intubation compared to conventional
laryngoscopy probably because of lack of optimal skill and performance anxiety. Second attempts for ETI were
significantly more in the former group because of trainer reassurance of visibility of attempt on VL screen.