1. ALERT Presentation:
Methodological Analysis and
Investigation of Novel Techniques Aimed
at Improving Intubation in Neonates
(MAINTAIIN)
Taylor Sawyer, Laura Haubner, Lamia Soghier,
Lindsay Johnston, Kathryn Colacchio, Jim Barry,
Judy LeFlore, Adam Cheng, David Kessler, Marc
Auerbach

2. Background
• Endotracheal intubation is a critical procedural skill
• At no time is endotracheal intubation more common, or
challenging, than the neonatal period
– ~ 40,000 newborns/year require assistance with breathing at birth,
including possible intubation
– 1st or 2nd attempt success rates range from 33 to 69%
• Procedural skills degrade rapidly if not used, or practiced
• Long intervals between intubation training and/or clinical
experience may be a factor in the suboptimal performance
of neonatal intubation
• Minimal refresher intervals to maintain skill is unknown

3. Approach
• 3 Phase multi-center study:
– Phase I: Develop a set of valid and reliable tests to
evaluate competency at neonatal intubation
– Phase II: Analyze intubation skill degradation &
define optimal refresher training intervals
• Skill degradation curves
• Power functions of skill degradation
– Phase III: Randomized comparison of virtual reality-
based vs. manikin-based simulation refresher
training at maintaining intubation skills

4. PICO Question
• Population
– Residents, fellows and attendings
• Intervention
– Phase II: Mastery learning and later retesting of skill retention
– Phase III: Virtual reality-based simulator
• Comparison
– Phase II: Intubation performance at 2, 4 or 6 mo after mastery learning
– Phase III: Manikin-based intubation simulator
• Outcome
– Phase II: Skill degradation curves and power functions of skill
degradation
– Phase III: Impact of refresher training methods (manikin vs. VR) on skill
maintenance over time

5. 3 Questions
• What tests do we need to develop to determine
competency at neonatal intubation and how do
we validate them?
– Checklist, GRS, times, knowledge-based exam, etc.
• Is it feasible to develop a de novo neonatal
intubation virtual reality simulator for the study?
• What issues do we need to consider when
standardizing the research across study sites?