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Am J Perinatol 2025; 42(13): 1743-1753
DOI: 10.1055/a-2533-2465
Original Article

Improving First-Attempt Intubation Success Rate in a Level IV Neonatal Intensive Care Unit Through the Use of a Video Laryngoscope: A Quality Improvement Initiative

Authors

  • Stephanie Martinez 

    1   Division of Neonatology, University Hospitals of Cleveland, Rainbow Babies and Children's Hospital, Cleveland, Ohio
    2   Division of Neonatology, Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee

  • Monika Bhola

    1   Division of Neonatology, University Hospitals of Cleveland, Rainbow Babies and Children's Hospital, Cleveland, Ohio
    3   Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio

  • Nori Mercuri Minich

    1   Division of Neonatology, University Hospitals of Cleveland, Rainbow Babies and Children's Hospital, Cleveland, Ohio
    3   Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio

  • Charlene Nauman

    1   Division of Neonatology, University Hospitals of Cleveland, Rainbow Babies and Children's Hospital, Cleveland, Ohio

  • Kathleen Deakins

    1   Division of Neonatology, University Hospitals of Cleveland, Rainbow Babies and Children's Hospital, Cleveland, Ohio

  • Allison Oliverio

    1   Division of Neonatology, University Hospitals of Cleveland, Rainbow Babies and Children's Hospital, Cleveland, Ohio

  • Gulgun Yalcinkaya

    1   Division of Neonatology, University Hospitals of Cleveland, Rainbow Babies and Children's Hospital, Cleveland, Ohio
    3   Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio

Funding This work was supported by internal grant funding from the Hearst Funds which covered presentations at local and national conferences and offset publication costs.
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Abstract

Objective

There is increasing evidence that the use of a video laryngoscope improves first-attempt intubation rates in neonates. The goal of this quality improvement initiative was to improve the first-attempt intubation success rate from 45 to 65% in 2.5 years through the introduction and increased use of a video laryngoscope in a level IV neonatal intensive care unit (NICU).

Study Design

We utilized the Model for Improvement with plan-do-study-act cycles targeted at increasing buy-in and comfort with the use of a video laryngoscope. Data on 418 intubations were collected from November 2021 to April 2024.

Results

Through increasing routine use of the video laryngoscope, achieved via a staggered introduction of the device, creation of reference materials, and coaching workshops, we improved the overall first-attempt intubation success rate from 45 to 57% during the intervention period.

Conclusion

We increased the first-attempt success rate of intubations in the NICU by effectively implementing the use of a video laryngoscope into daily practice.

Key Points

  • Neonatal intubations have low success rates, but video laryngoscopy improves success especially for those with less experience.

  • This study shows that video laryngoscopy adoption in a neonatal ICU improved first-attempt intubation rates.

  • This study contributes to neonatal intubation and video laryngoscopy literature from a quality improvement perspective.

Keywords

intubation - neonate - video laryngoscope - quality improvement

Note

This work was presented at the 102nd Perinatal and Developmental Medicine Symposium, Baltimore, MD, September 2023; Annual Education Retreat, Case Western Reserve University School of Medicine, Cleveland, OH, May 2023; Pediatric Academic Societies, Washington, DC, April 2023; Quality Improvement Coaching Conference, Charlotte, NC, October 2022; and Vermont Oxford Network Annual Quality Congress 2022 Virtual Poster Expo, Chicago IL, September 2022.


Ethical Approval

For this quality improvement initiative, the University Hospitals Institutional Review Board (IRB) determined this initiative is not research involving human subjects, and thus does not require IRB review and approval.


Authors' Contributions

S.M., C.N., K.D., A.O., M.B., and G.Y. made substantial contributions to the conception and design, acquisition of data, and contributed final approval of the version to be published. S.M., N.M., M.B., and G.Y. additionally made substantial contributions to the analysis and interpretation of data, and to drafting or critically revising the study for important intellectual content.




Publication History

Received: 03 October 2024

Accepted: 04 February 2025

Article published online:
06 March 2025

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