Background: Endotracheal intubation (ETI) of pediatric patients in the emergency setting is a critical skill that all EM physicians are expected to obtain during training, however, many trainees receive few opportunities to intubate pediatric patients. Our intent was to show that skills obtained in any ETI are generalizable and will correlate to skilled pediatric ETI.
Methods: This prospective cohort study set in a single urban academic ED included a convenience sample of 25 EM residents. Each participant performed direct laryngoscopy and ETI on 2 simulated human manikins: a pediatric manikin with a Miller 1 blade, and an adult manikin with a Macintosh 3. Participants were measured in time to successful ETI, total number of attempts, number of esophageal intubations, psychomotor skill (PS) and technical skill (TS). PS and TS each were assessed by 2 independent raters blinded to performance on the opposite modality on a scale of 1-8. PS represented characteristics such as hand eye coordination and dexterity. TS represented characteristics such as positioning and ability to avoid “rocking” the blade. The electronic medical record was queried to determine the number of intubations performed by each participant during residency.
Results: Pediatric patients represented just 3% (15/462) of the total intubations performed by participants prior to the study – with 17/25 having performed no pediatric ETI. There was a strong positive correlation between total intubations performed (adult and pediatric) and TS (r = 0.75, p < 0.0001, 95%CI = 0.50-0.88) and PS (r = 0.76, p < 0.0001, 95%CI = 0.53-0.89) when performing ETI on the pediatric mannikin. There was no correlation between experience and time to successful ETI (r =-0.10, p = 0.63, 95%CI = -0.47-0.31), number of attempts (r = 0.05, p = 0.83, 95%CI = -0,36-0,43) or esophageal intubations (r = -0.08, p = 0.72, 95%C I= -0.46-0.33) on the pediatric model.
Conclusion: Performance metrics for TS and PS when intubating pediatric models improves significantly with primarily adult intubating experience.