Intubating extremely premature newborns: a randomised crossover simulation study.

OBJECTIVE

Determine whether tracheal intubation of extremely low birthweight (ELBW) neonates is more successful with a size-0 or size-00 Miller laryngoscope blade.

DESIGN

Randomised crossover simulation study.

SETTING

Simulated neonatal intensive care unit environment.

STUDY SUBJECTS

Neonatology physicians and nurse practitioners (n=55).

INTERVENTIONS

Subjects performed four intubations in succession on a high-fidelity ELBW manikin with size-0 Miller and size-00 Miller blades from two different manufacturers. The intubation sequence was randomised. Intubations were recorded and scored for time analysis. Subjects completed surveys about blade preferences before and after completing the series of intubations.

MAIN OUTCOME MEASURES

Total laryngoscopy time and first attempt success in less than 30 s.

RESULTS

There was no difference in total laryngoscopy time (median 23.7 vs 20.6 s) or first attempt success in <30 s (67.3% vs 69.1%) between the size-0 and size-00 blades. Differences were noted between the same size blades made by different manufacturers. Among subjects expressing a prestudy blade size preference, there was no difference in laryngoscopy time or first attempt success between blades. Regardless of blade size, subjects were less successful with the first blade in the randomised sequence.

CONCLUSIONS

Our findings support the Neonatal Resuscitation Program recommendation identifying the size-00 blade as optional equipment. Operators need to be aware of design variations between manufacturers and they may benefit from 'just-in-time' training with a manikin prior to intubating a live patient.