Evaluation of the Parker TrachView™

A-1122

October 15, 2002
9:00:00 AM - 12:00:00 PM
Orange County Convention Center, Room E

Evaluation of the Parker TrachView® as a Teaching Tool for Direct Laryngoscopy and Endotracheal Intubation

Fernando A. Gutierrez, M.D.; Wade A. Weigel, M.D.; H. Gregg Shuler, B.A.; John Stene, M.D., Ph.D.; Robert Marine, Ph.D.

Anesthesiology, Pennsylvania State University, College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania

Introduction: Direct laryngoscopy (DL) and endotracheal (ET) intubation are basic skills an anesthesiologist must master. Multiple methods have been developed to teach these skills. The Parker TrachView® is an FDA approved videoscope (VS) which is placed inside an ET tube without protruding beyond the tip. It was created to improve visualization during difficult intubations while utilizing standard intubation technique. The VS image from the tip of the ET tube can be viewed and or recorded in real time. The purpose of this study is to evaluate the Parker TrachView® as a tool for teaching DL and ET intubation in anesthesiology. Traditionally, faculty members have only had an external view when teaching endotracheal intubation. As a result faculty must make judgements about clinical performance without a direct view of the airway anatomy as the ETT is placed. This leaves faculty susceptible to inaccurately ascribing intubation difficulties to either the patient anatomy or the resident skill. The VS with videotaping provides an opportunity for faculty and resident to review and discuss the positive and negative aspects of intubation.

Methods: This study combines participant observation, video-tape analysis, survey, and focused interview methods. Residents performed routine ET intubations on adult patients scheduled for surgery under GA. The anesthesia providers selected the induction protocol and intubation was recorded through the TrachView VS. Neither the resident nor faculty viewed the VS output in real time. After each intubation the resident and faculty completed a web based survey, reviewed the videotape, and then completed a post survey.

Results: Eleven intubations were included in the study. In four cases completely new problems were discovered on faculty review of the videotape. In 3 of these 4 cases the intubation was initially perceived as smooth. In 6 cases the faculty found the problems to be different than originally perceived. In 4 cases where a single problem was identified pre review, multiple problems were identified post review. Overall, faculty identified problems in 10 of 11 cases after reviewing the videos and identified two or more problems in 8 of those cases. No resident identified more than one problem pre or post viewing. Resident year did not predict type or number of problems.

Discussion: The results of this small, preliminary study reveal that VS can improve faculty awareness of difficulties encountered during the placement of an ET tube. Faculty frequently identified more problems after video review and hence perceived the VS as a helpful teaching tool. Residents did not perceive any change in teaching and identified few problems through video review. This discrepency may be a function of how the tool was used by faculty, teaching methods, or resident receptivity to the review process.
Anesthesiology 2002; 96: A1122