Use of Biomechanical Motion Analysis to Evaluate Endotracheal Intubation Skill in a Simulated Clinical Setting
This study evaluated, using motion capture technology, the performance characteristics of novice and experienced medical personnel performing endotracheal intubation in a simulated clinical setting. Few objective measures exist that quantify the differences in intubation techniques between providers of various skill levels. These measures are inadequate for providing useful feedback towards training or performance-based research. Motion analysis may be a potential solution for the quantitative evaluation of endotracheal intubation among healthcare professionals of different skill levels. This study hypothesized that experienced personnel would exhibit movement patterns associated with higher performance and efficiency when compared to novice personnel. Twelve subjects were recruited for this study, among whom eight were novice participants and four were expert participants, based on the number of times they had performed endotracheal intubation. Each subject donned a full body 41 marker motion capture suit and performed simulated endotracheal intubation on an Airway mannequin using a Macintosh blade-fitted laryngoscope. Intubation success was defined by visible lung inflation of the mannequin. The obtained motion capture data was used to calculate path length, average path speed and use time of the laryngoscope, as well as the overall intubation time. Angular ranges of motion were calculated for the left wrist, elbow, the neck, and both knees of study subjects. Experts, when compared to novices, intubate faster and with lower overall movement (path length). One way ANOVA and two sample t-tests were conducted on all outcome variables, wherein significant p-values were obtained from the wrist abduction/adduction (p = 0.009) and elbow abduction/adduction (p=0.002) ranges of motion among novices and experts, indicating significant difference. Combined with a lower completion time and the lower overall laryngoscope movement, the lower range of motion for the wrist and the elbow in experts may indicate that experts are implementing finer, more economic maneuvers in order to achieve successful intubation. These results supports the study hypothesis that experienced personnel, compared to novice, will exhibit measurable movement patterns associated with higher performance and efficiency.
Table of Contents
Introduction -- Background -- Study -- Conclusion -- Appendix A. Equipment photographs, layout schematics, study illustrations -- Appendix B. Tables -- Appendix C. MATLAB Code -- Appendix D. Study forms and documents