First-attempt success significantly higher in intervention group receiving expert intubation coaching on a manikin
By Elana Gotkine HealthDay Reporter
TUESDAY, Dec. 17, 2024 (HealthDay News) — For inexperienced clinicians, just-in-time training leads to increased first-attempt success of infant intubation, according to a study published online Dec. 16 in The BMJ.
Stephen G. Flynn, M.D., from Harvard Medical School in Boston, and colleagues examined whether training provided to inexperienced clinicians just before performing a high-stakes procedure can improve procedural care quality in a noncrossover, parallel-group trial. Volunteer trainees, including pediatric anesthesia fellows, residents, and student-registered nurse anesthetists from 10 regional training programs, were block-randomized by training roles; trainees were intubating infants aged 12 months and younger with an American Society of Anesthesiology physical status classification of I to III. The trainee treatment group received preoperative just-in-time expert intubation coaching on a manikin within one hour of infant intubation, and the control group received unstructured intraoperative instruction.
Overall, 172 participants were randomly assigned and 153 were analyzed. The 153 trainees (83 control and 70 treatment) performed 515 intubations (283 control and 232 treatment). The researchers found that first-attempt success was 91.4 and 81.6 percent in the trainee treatment and control groups, respectively, in the modified intention-to-treat analysis (odds ratio, 2.42). Secondary outcomes favored the intervention, with significantly lower cognitive load and improved competency. Complications were lower for the intervention group, but not significantly so.
“Integrating a just-in-time approach into airway management training could improve patient safety and serve as a proof of concept for improving high-stakes procedural outcomes more broadly,” the authors write. “Randomized evaluation in other settings is warranted.”
Two authors disclosed ties to the pharmaceutical industry; one also disclosed ties to the publishing industry.
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