Maintenance of basic endotracheal intubation skills with direct or video‐assisted laryngoscopy: A randomized crossover follow‐up study in inexperienced operators

BACKGROUND: Laryngoscopy is a difficult skill to acquire and maintain and even more so by less frequent users. Numerous studies have compared limitations of direct laryngoscopic (DL) and video‐assisted laryngoscopic (VL) techniques for endotracheal intubation in different scenarios, but individual retention over time of intubation skills with either technique has, to our knowledge, never been reported. The primary aim of this study was to evaluate to what extent recently acquired basic skills of endotracheal intubation, based on DL or VL, are being maintained over time by inexperienced operators. METHODS: This randomized crossover follow‐up study was designed to compare endotracheal intubation with direct (McIntosh blade) versus video‐assisted (hyperangulated blade) laryngoscopy by 20 undergraduate medical students in identical manikins three months after brief basic intubation training with no further intubation practice. RESULTS: No significant differences in skills retention were found between DL and VL regarding the time for successful intubation or number of adverse events. However, the first intubation was significantly slower regardless of the technique compared with the last one three months earlier. Furthermore, DL was slower and associated with more incidents of esophageal intubation and dental manipulation than was VL. CONCLUSIONS: Although basic intubation skills seem to be similarly well maintained over time regardless of the laryngoscopic technique, endotracheal intubation with VL by inexperienced operators is faster and associated with fewer adverse events than is DL after a three‐month period with no further intubation training.