Video analysis of neonatal intubations using video laryngoscopy: a prospective comparison of clinical practice with resuscitation guidelines.

Background: The Neonatal Resuscitation Program recommends direct laryngoscopy (DL) as the primary method for neonatal intubation. Video laryngoscopy (VL) is suggested as an option, particularly for training novice operators or for intubating infants with difficult airways. The programme outlines specific steps for intubation, including managing the external environment and techniques for visualising key anatomical landmarks. It is unclear whether the DL method can be effectively applied to VL.

Objectives: To determine the degree of adherence to resuscitation guidelines during intubation using VL, and to examine the relationship between guideline adherence and intubation success.

Methods: In a cohort of newborn infants who were intubated with VL, we simultaneously recorded the view obtained with the video laryngoscope and an external view of the procedure with a GoPro video camera, and synchronised the recordings for analysis. In each set of recordings, we assessed infant and operator positions, interventions during the procedure, and the anatomical landmarks visualised.

Results: We assessed 95 intubation attempts in 57 infants (median corrected gestational age: 28 weeks; median weight: 1160 g). Sixty-six of these attempts (69%) were successful. Operators spent more time attempting to insert the endotracheal tube through a visible glottis than locating it. Sixty-six (69%) attempts were performed with an appropriate lift manoeuvre. The vocal cords were visualised in only 58 (61%) attempts, while the glottis was seen in 85 (89%).

Conclusions: Neonatal intubation using VL differed from the technique recommended in resuscitation guidelines. Revised guidelines considering the use of VL may be warranted.