Asphyxia Neonatorum
Conditions
Brief summary
The overall goal of this study was to create a simulation environment with repeated practice for residents and intense, immediate feedback. Repeated simulations for neonatal resuscitation when coupled with clinical experience have been shown to improve resident confidence.The investigators sought to determine if resident exposure to individual training and video laryngoscopy using the C-MAC video laryngoscope would improve cognitive skills and decrease intubation times in a neonatal manikin. The primary outcome was time to intubation after one year. The secondary outcome was the ability to retain cognitive instruction related to intubation
Detailed description
Objective: Tracheal intubation of infants and children is a critical lifesaving skill, but many upper level pediatric residents are unable to successfully intubate neonates or pediatric patients in a timely manner. Simulation has been shown to be effective in teaching procedural skills, but it is not known if improvements in intubation skills can persist. The investigators sought to determine if video laryngoscopy could be used to enhance resident intubation skills that would be retained for one year. Methods: There were 67 Pediatric and Internal Medicine/Pediatric residents, levels 1-4, who completed the study and were randomized by month of service into non-intervention (NI, n= 36) and intervention (IN, n=31) groups. IN residents observed the intubation portion of the Neonatal Resuscitation Program (NRP) training video and received cognitive instruction and 30 minutes of hands on instruction using a video laryngoscope. At the study's conclusion, 12 months after enrollment, residents completed a survey of intubations of live patients over the past year, a cognitive assessment of intubation, and were timed on intubating a manikin. Results were analyzed by Student's T-Test.
Interventions
Routine training in neonatal resuscitation, intensive cognitive and hands on training for intubating neonates using manikins in a simulation lab.
Routine training in neonatal resuscitation but no added experience in simulation lab.
Sponsors
Study design
Eligibility
Inclusion criteria
* Pediatric residents
Exclusion criteria
* Residents from other departments * Neonatology fellows * Medical students * Medical school Faculty
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Skill in Intubating Neonatal Manikin | Up to two minutes | Time in seconds needed to intubate neonatal manikin Skill test on neonatal resuscitation in simulation lab |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Knowledge Concerning Intubation of Neonates | 30 minutes | Score on cognitive test on intubation of neonates.Scores ranged on scale from 0 to 21 , with higher score indicating greater knowledge (better outcome). |
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Education for Intubation Skills Interventions: Training for Pediatric Advanced Life Support (PALS) and Neonatal Resuscitation Program (NRP); 7 minute excerpt from the NRP training video regarding intubation; cognitive instruction which consisted of equipment needed for intubation; hands on instruction using the Storz video laryngoscope with manikins in simulation lab.
Education for intubation skills: Routine training in neonatal resuscitation, intensive cognitive and hands on training for intubating neonates using manikins in a simulation lab. | 37 |
| No Added Education for Intubation Skills Interventions: Training for Routine Pediatric Advanced Life Support (PALS) and Neonatal Resuscitation Program (NRP) training; no additional training for intubating newborns.
No added education for intubation skills: Routine training in neonatal resuscitation but no added experience in simulation lab. | 45 |
| Total | 82 |
Baseline characteristics
| Characteristic | Education for Intubation Skills | No Added Education for Intubation Skills | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 37 Participants | 45 Participants | 82 Participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 0 Participants | 4 Participants | 4 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 37 Participants | 41 Participants | 78 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 5 Participants | 4 Participants | 9 Participants |
| Race (NIH/OMB) Black or African American | 1 Participants | 3 Participants | 4 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 31 Participants | 38 Participants | 69 Participants |
| Region of Enrollment United States | 37 participants | 45 participants | 82 participants |
| Sex: Female, Male Female | 21 Participants | 35 Participants | 56 Participants |
| Sex: Female, Male Male | 16 Participants | 10 Participants | 26 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 37 | 0 / 45 |
| serious Total, serious adverse events | 0 / 37 | 0 / 45 |
Outcome results
Skill in Intubating Neonatal Manikin
Time in seconds needed to intubate neonatal manikin Skill test on neonatal resuscitation in simulation lab
Time frame: Up to two minutes
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Education for Intubation Skills | Skill in Intubating Neonatal Manikin | 23.4 seconds | Standard Deviation 22.4 |
| No Added Education for Intubation Skills | Skill in Intubating Neonatal Manikin | 39.9 seconds | Standard Deviation 38.2 |
Knowledge Concerning Intubation of Neonates
Score on cognitive test on intubation of neonates.Scores ranged on scale from 0 to 21 , with higher score indicating greater knowledge (better outcome).
Time frame: 30 minutes
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Education for Intubation Skills | Knowledge Concerning Intubation of Neonates | 15 scores on a scale | Standard Deviation 1.7 |
| No Added Education for Intubation Skills | Knowledge Concerning Intubation of Neonates | 13.1 scores on a scale | Standard Deviation 2.3 |