482 - Intubating premature Infants with a finger operated two member endotracheal tube guide was superior to the use of a stiff wire trocar or a Magill forceps to guide the tubes' tip into the trachea

Poster Number: 482
Publication Number: 482.231

Juan N. Walterspiel, University of Texas Southwestern Medical School, Menlo Park, CA, United States

Background: The acquisition of intubation skills requires training and practice.  Performance reviews find frequent esophageal intubations and emergency intubations take place without experts  Inexpensive new intubation devices have not been evaluated and seem to suffer from "low tech orphan" $ return syndrome.

Objective: To compare premature infant intubations using a two-component (push and pull) finger-ring operated guide with standard of practice intubations (SOP) performed with the help of a bent wire trocar or a Magill forceps.

Design/Methods: Planned and supervised re-intubations of premature infants were performed by pediatric second and third-year residents who agreed to be observed. Daytime intubations were sequentially assigned 1:1, to occur with a new finger-operated guide that was developed by the investigator or with the help of a wire trocar or a Magill forceps according to each resident's preference.  Time from endoscope in place to successful intubation, abortion of an  attempt, or esophageal int, was recorded . The institutional review board (IRB) limited this open-label, controlled study to 12 intubations.

Results: The IRB halted the study for superiority with the experimental guide,  Of the six intubations with the guide, one was not timed as resident asked an attending to take over after intubation of the esophagus, There were 5 aborted intubation attempts and 3 esophageal int, during 6 intubations in SOP group, (ratio of 1,16) and one esophageal int,  (ratio of 0.16), in the guide group.  There was a total of 608 ss of intubation time in the conventional group and 249 seconds in the experimental group. The last number includes an added 71 s. for the longest intubation time recorded in SOP group.  It took a mean of 45.8 , a median of 48.5 seconds, range 28 to 71 seconds for the successful intubations in the SOPgroup (n=6), and a mean of 35,6 with a median of 30.0 seconds, range 15 to 68 (n=5) with new device.Conclusion(s): The new finger-operated intubation guide that was intubation- hand-held and finger ring operated to guide the tube tip gently over the epiglottis into the trachea while leaving the endotracheal tube open for detection of air movements and CO2 , was superior to standard of practice intubation with a wire trocar or Magill forceps.  This inexpensive new guide would render neonatal intubation less asphyxiating in general and in emergency situations where an experienced intubator may not be available.