744 - Improving Intubation Success for Learners Using  Video Laryngoscopy

Publication Number: 1720.744

Anthony Bernick, Cleveland Clinic Children's, Willowick, OH, United States; Ann L.. Farah, Cleveland Clinic Children's, Rocky River, OH, United States; Abdul Kader S. Surti, Cleveland Clinic Children's, Lorain, OH, United States; Victoria Smith, Cleveland Clinic - Fairview Hospital, Cleveland, OH, United States; SABINE IBEN, Cleveland Clinic Children's, Cleveland, OH, United States

Background: Intubation is a high risk, high acuity procedure . Multiple attempts are associated with adverse events. Using the NEAR4NEOS database the average for first attempt intubation success was 67.8% in 2024 . In our center, first attempt success from 2022-2024 has ranged from 51-57% overall, with trainees having a success rate of 62.3%. An overall decrease in the number of intubations due to practice changes has led to decreased learning opportunities/experience of trainees. Previous studies have shown that video laryngoscope (VL) use leads to increased 1st attempt success and decreased time to achieve proficiency particularly for trainees

Objective: The primary objective was to increase overall VL use. A secondary objective was to increase the trainee first attempt success rate via VL use .

Design/Methods: We started a quality improvement project with various PDSA cycles over the course of one year to increase the use of VL. Interventions included procedural simulation sessions, fellow boot camps, educational didactics and surveys to identify barriers. Data was collected quarterly to review VL use, first attempt success for VL vs direct laryngoscopy, and trainee first attempt success for VL vs direct laryngoscopy intubation. We included as trainees residents, nurse practitioners with less than one year experience and first year fellows. The data was then correlated to each intervention.

Results: After each successive PDSA cycle the use of VL increased. Prior to any interventions the baseline use of VL was 14 across two years of data, following the intervention VL use increased to at least 14 in a quarter. Trainee first attempt success with VL improved from 50% to 71% following the interventions. Video use success rate went from 78% to 75% post intervention, but as mentioned previously, the number of VL intubations rose dramatically. VL use for first attempt success has consistently performed better with VL success ranging from 72-100% for first attempt success rate, while all intubations have had a first attempt success rate ranging from 54-62%. The overall trainee 1st attempt success rate over the course of the project has remained stagnant pre and post intervention at 62.3 vs 61.2% respectively for all types of intubations.

Conclusion(s): We successfully increased the use of a videoscope in our institution and showed improved first attempt intubation success for learners. However, the device is still not uniformly used in eligible patients with a significant number of neonates intubated by direct laryngoscopy which is reflected by the unchanged overall first intubation success.

Intubation Data Table
Table comparing data quarterly pre and post interventions

Intubation Run Charts
Various run charts showing pre and post intervention data
Video Use: Shows increasing VL use across duration of interventions.
Video vs All 1st Attempt Success: VL consistently outperforming all intubations in terms of first attempt success.
Dates in charts refer to:
4/3/24: Education Session and start of monthly Procedural sim sessions
6/27/24: Surveys to identify difficulties with VL use
7/1/24: Fellows boot camp with procedural sim taught by NICU and Peds Anesthesia attendings
2/1/25: Staff meeting to discuss current state of project and reiterate importance of use