2019 Volume 10 Issue 2 Pages 51-61
Background: Endotracheal intubation is a core skill for airway management. With regard to the expertise of endotracheal intubation among physicians using a rigid laryngoscope, the body movement, the head movement, and movement of the gaze during the intubation procedure vary for each physician. This study aimed to test the hypothesis that the duration of endotracheal intubation, head movement, and movement of gaze intra-procedurally differ between experts and novices and assessed these factors using both a motion capture system and eye-tracking system in a medical simulation setting.
Methods: After obtaining institutional approval, individuals who were either novices or experts at endotracheal intubation using Macintosh laryngoscopes were recruited. Body motion and gaze distribution during endotracheal intubation of a mannequin were recorded and analyzed using a motion capture system and eye-tracking system. The values obtained were compared between the novices and experts.
Results: The endotracheal intubation time was significantly shorter in experts (21.6 ± 7.6 sec vs 30.4 ± 8.3 sec, p=0.002), and the range of vertical head movement was smaller in experts (13.1 ± 7.7 cm vs 39.2 ± 8.1 cm, p<0.001), with significantly different trajectory, than those in novices. The ratio of downward gazing was significantly higher in experts (99.6 [96.7–100]% vs 32.4[18.8–43.4]%, p<0.001), and that of proximal gazing was significantly higher in novices (78.1 [67.9–85.6]% vs 37.2 [6.4–82.1]%, p=0.011).
Conclusion: Body movement and gaze dynamics during endotracheal intubation with rigid laryngoscope differed between novices and experts. This system is a potential and feasible tool for evaluating the practice of endotracheal intubation.
