Dr. Al-Subu id a pediatric critical care physician and a member of the pediatric heart surgery team at the American family Children’s Hospital.
He is one of the two inaugural winners of a research grant from the CCK Because of McKenah Fund. The following is a summary of his project.
Making airway intubation safer through novel educational technologies
Emergency endotracheal intubation (insertion of a breathing tube into the airway) is a life-saving and necessary procedure for almost all critically ill children in Pediatric Intensive Care Units (PICUs). However, emergent tracheal intubation procedures are associated with a high risk of complications, poor outcomes and crippling healthcare costs. The occurrence of adverse tracheal intubation-associated events (TIAEs) such as unrecognized intubation of the esophagus or stomach contents entering the airway results in sudden, dangerous, severe drops in blood oxygen levels. This can very rapidly result in cardiac arrest and subsequent irreversible brain damage.
The key to maximizing clinician expertise in this scenario is to provide rigorous training for these emergent scenarios.
Yet, emergent intubations are performed by the trainee in a chaotic, highly stressful environment, with the supervising physician unable to directly observe and visualize what the trainee is seeing in the airway while placing the breathing tube.
This leaves no opportunity for meaningful, real-time coaching or feedback, as the supervisor cannot “see what the trainee sees” due to the limited view of the airway afforded by direct laryngoscopy. This result of the current training paradigm is a highly inconsistent and puts our most vulnerable patients at risk.
In order to make lasting improvements, the teaching paradigm for emergent intubations will need to be rapidly and drastically improved to ensure the dual missions of patient safety and optimal physician learning.
Newly designed video laryngoscopes providing the teacher with the view of the airway that the trainee is seeing under direct visualization. This allows trainees to continue to train in the standard intubating technique during emergent intubations, while the supervisor can provide real-time coaching and feedback to the trainee.
Dr. Al-Subu is undertaking a longitudinal observational study on this technology to establish a standardized system of training for this technology.
As he said during his interview with our grant committee: “This research will save the lives children here in Madison and the State of Wisconsin this year. Because our trainees take jobs in rural places like the Dakotas, northern Minnesota and as far away as islands in the Caribbean, it will have a multiplier effect in saving lives over decades."
CCK will provide a majority of the funding ($24,000) to support this study which will be critical for saving children’s lives.