A Simulation Study examining the Efficacy of Videolaryngoscopy in infants, children, and adolescents with Trisomy 21
1. The Difficult Pediatric Airway:
A Simulation Study Examining the
Efficacy of Videolaryngoscopy in
Infants, Children and Adolescents with
Trisomy 21
James Burhop DO, MS
PEM Fellow – CHKD/EVMS
Dr.Burhop@gmail.com
Mentor: Joel Clingenpeel MD, MPH
2. Hypothesis
Videolaryngoscopy provides an advantage
leading to successful intubation of a difficult
pediatric airway when compared with direct
laryngoscopy.
3. Goals & Objectives
Assess if pediatric emergency physicians can
successfully intubate and secure a difficult
pediatric airway with improved rates of tracheal
intubation using videolaryngoscopy when
compared with direct laryngoscopy in a manikin
with atlantoaxial instability and macroglossia.
4. Rationale
Our study looks to enhance safety and improve
patient outcome through simulation of difficult
pediatric airway scenarios with an emphasis on
laryngoscopic technology, curriculum
development and education.
5. Background
• It has been established that the videolaryngoscope is a
valuable tool in securing the successful tracheal intubation
of difficult airways in adult patients.
• There is minimal available evidence to gauge its efficacy
within the infant, child and adolescent populations.
• Literature is virtually devoid of simulation studies in
individuals with specific syndromes such as trisomy 21.
• Clinical encounters involving pediatric intubation are
uncommon when compared with adults, which highlights
the importance of developing realistic airway simulation
scenarios that create opportunities for practice with video
and direct laryngoscopes.
6. Methodology
• Performance features of direct laryngoscopy with Macintosh blades are
compared with videolaryngoscopy using the Storz CMAC scope.
• Cross-sectional and performed within a large tertiary children’s hospital
simulation center.
• Study participants are pediatric emergency medicine physicians with
fellowship training and difficult airway experience.
• Difficult pediatric airways are simulated with macroglossia, atlantoaxial
instability and neck immobilization.
• Study participants will view a pre-scenario videolaryngoscopy training
video that is unique to the specific simulation equipment available in our
simulation laboratory.
• Each study participant performs intubation during a difficult airway
scenario on an infant, child and adolescent manikin.
• The time to successful tracheal intubation is recorded along with
prevalence of first-attempt tracheal intubation using direct laryngoscopy
as compared to videolaryngoscopy.
7. References
• 1. Hung, C. K. A comparison of the Trachway
intubating stylet and the Macintosh laryngoscope in
tracheal intubation: a manikin study. Journal of
Anesthesia 2012; 26, 1491-6
• 2. Donoghue, A. J. Videolaryngoscopy Versus Direct
Laryngoscopy in Simulated Pediatric Intubation. Annals
of Emergency Medicine 2012; 12, 1532-6
• 3. Healy, D. W. Comparison of the glidescope, CMAC,
storz DCI with the Macintosh laryngoscope during
simulated difficult laryngoscopy: a manikin study. BMJ
Anesthesiology 2012; 12, 11