Cross-over study of novice intubators performing endotracheal intubation in an upright versus supine position

Joseph Turner, Timothy J. Ellender, Enola R. Okonkwo, Tyler M. Stepsis, Andrew C. Stevens, Christopher S. Eddy, Erik G. Sembroski, Anthony J. Perkins, Dylan Cooper

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

There are a number of potential physical advantages to performing orotracheal intubation in an upright position. The objective of this study was to measure the success of intubation of a simulated patient in an upright versus supine position by novice intubators after brief training. This was a cross-over design study in which learners (medical students, physician assistant students, and paramedic students) intubated mannequins in both a supine (head of the bed at 0°) and upright (head of bed elevated at 45°) position. The primary outcome of interest was successful intubation of the trachea. Secondary outcomes included log time to intubation, Cormack–Lehane view obtained, Percent of Glottic Opening score, provider assessment of difficulty, and overall provider satisfaction with the position. There were a total of 126 participants: 34 medical students, 84 physician assistant students, and 8 paramedic students. Successful tracheal intubation was achieved in 114 supine attempts (90.5 %) and 123 upright attempts (97.6 %; P = 0.283). Upright positioning was associated with significantly faster log time to intubation, higher likelihood of achieving Grade I Cormack–Lehane view, higher Percent of Glottic Opening score, lower perceived difficulty, and higher provider satisfaction. A subset of 74 participants had no previous intubation training or experience. For these providers, there was a non-significant trend toward improved intubation success with upright positioning vs supine positioning (98.6 % vs. 87.8 %, P = 0.283). For all secondary outcomes in this group, upright positioning significantly outperformed supine positioning.

Original languageEnglish (US)
Pages (from-to)1-6
Number of pages6
JournalInternal and Emergency Medicine
DOIs
StateAccepted/In press - Jun 14 2016

Fingerprint

Intratracheal Intubation
Supine Position
Intubation
Cross-Over Studies
Students
Physician Assistants
Allied Health Personnel
Medical Students
Tongue
Manikins
Trachea

Keywords

  • Airway management
  • Education
  • Intubation
  • Simulation

ASJC Scopus subject areas

  • Emergency Medicine
  • Internal Medicine

Cite this

Cross-over study of novice intubators performing endotracheal intubation in an upright versus supine position. / Turner, Joseph; Ellender, Timothy J.; Okonkwo, Enola R.; Stepsis, Tyler M.; Stevens, Andrew C.; Eddy, Christopher S.; Sembroski, Erik G.; Perkins, Anthony J.; Cooper, Dylan.

In: Internal and Emergency Medicine, 14.06.2016, p. 1-6.

Research output: Contribution to journalArticle

Turner, Joseph ; Ellender, Timothy J. ; Okonkwo, Enola R. ; Stepsis, Tyler M. ; Stevens, Andrew C. ; Eddy, Christopher S. ; Sembroski, Erik G. ; Perkins, Anthony J. ; Cooper, Dylan. / Cross-over study of novice intubators performing endotracheal intubation in an upright versus supine position. In: Internal and Emergency Medicine. 2016 ; pp. 1-6.
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