P1.187: Evaluating the Introduction of a New Video Laryngoscope on Intubation Success and Safety in Extremely Low Birthweight Infants

Background: Endotracheal intubation for extremely low birthweight (ELBW; < 1000g) infants is challenging, with suboptimal success rates and frequent adverse events. Video laryngoscopy (VL) has been linked to improved neonatal intubation success and safety, but the available blade sizes have limited its use among ELBW infants. The NeoView VL system overcomes this barrier with expanded blade sizes down to 000. Research evaluating the initial clinical impact of introducing new intubation tools such as the NeoView is limited. This study compared intubation success and safety before, during, and after NeoView introduction in a Level 3 neonatal intensive care unit (NICU) among ELBW infants.

Methods: This single-center retrospective cohort study analyzed prospectively collected intubation data from the NEAR4NEOS airway registry. Three phases of NeoView introduction were analyzed: pre-implementation, during implementation, and post-implementation. The pre-implementation phase included the last 40 direct laryngoscopy (DL) intubations before NeoView implementation. The implementation phase spanned an 18-month period and included the first 40 NeoView intubations. The post-implementation phase included 40 NeoView intubations following the implementation phase. Only intubations performed in the NICU on ELBW infants were included. Exclusion criteria consisted of intubations done in the delivery room and those performed by non-NICU providers (i.e., anesthesia and otolaryngology). Primary success and safety outcomes were first-attempt success and any tracheal intubation-associated events (TIAEs), respectively. Secondary outcomes included the number of intubation attempts, severe TIAEs, severe desaturations, and bradycardia. Descriptive statistics summarized patient, provider, and practice characteristics by phase. Univariable analysis compared patient, provider, and practice characteristics, as well as outcomes between phases. Multivariable analysis was not conducted given limited outcome counts. Statistical significance was set at p< 0.05. NEAR4NEOS received IRB approval (IRB 09–007253).

Results: A total of 120 intubation encounters (40 per phase) were analyzed. Patient, provider, and practice characteristics were similar across phases, with the exception of chronic respiratory failure (Table 1). No significant differences in success or safety outcomes were observed between the pre-implementation and implementation phases (Table 2). However, the post-implementation phase had significantly fewer TIAEs compared to both pre-implementation (p=0.04) and implementation phases (p=0.04), as well as fewer severe TIAEs as compared to the implementation phase (p=0.02).

Conclusion: The introduction of the NeoView did not immediately impact intubation success or safety in ELBW infants. However, with continued use, safety outcomes significantly improved, suggesting a learning curve associated with adopting new intubation tools. These findings highlight the importance of sustained experience and training in optimizing the benefits of introducing new airway management technologies.