Introduction
The competency of using video laryngoscopes (VL) for double-lumen tube (DLT) endobronchial
intubations can be improved with constant training as assessed by measuring the learning
curves. We hypothesized that the time to DLT intubation would be reduced over the
intubation attempts.
Methods
Forty-two novice medical students unfamiliar with DLT intubation were randomly allocated
to two sequences, including DLT intubation using King Vision and McGrath VLs, in a
randomized crossover manikin study. Each participant completed 100 DLT intubation
attempts on both simulated airways using the study devices (25 attempts for each).
The primary outcome was the time to DLT intubation. The secondary outcomes included
the best glottic view, optimizing maneuvers, and intubation first-pass success. The
learning curve for each participant was measured using the Cumulative Sum (CUSUM)
analysis. [1,2]
Results
The use of King Vision VL was associated with significantly shorter time to DLT intubation
(p <0.044 and p<0.05, respectively) and a higher percentage of glottic opening (POGO)
compared to the McGrath VL (p <0.011 and p<0.002, respectively) in the simulated ‘easy’
and ‘difficult’ over most of the intubation attempts. In the simulated ‘easy’ airway,
the first-pass success ratio was higher when using the King Vision® VL (median [Minimum-Maximum]
100% [100% - 100%] and 100% [88% - 100%], p = 0.012). The results of the CUSUM analysis
are shown in Figure 1.
Figure 1. The CUSUM analysis charts for the 25 intubation attempts using the King
Vision® and McGrath® in the simulated ‘easy’ and ‘difficult’ airway models. Lines
CUSUM for P1 to CUSUM for P42 represent the learning curves of individual students.
Orange and blue Lines h1 and h0 represent upper and lower control limits of 2.24 and
-2.24, respectively. Y-axis values represent multiples of h1 and h0. P1….P42: Participant
1….Participant 42. If the learning curve crosses H0 from above, it means that the
measured percentage failure does not differ from the acceptable failure rate with
a type 1 error equal to œ and a type 2 error equal to ß). When the student crosses
the H0 boundary, it is considered that the proficiency level has been achieved for
the procedure assessed. [1,2]
Discussion
Novice medical students developing skills over intubation attempts translated into
faster DLT intubation and higher success rate on simulated ‘easy’ and ‘difficult’
airways. A median of 9 DLT intubations is required to achieve a 92.2% or greater DLT
intubation success degree.
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© 2021 Published by Elsevier Inc.
