Endotracheal intubation performance at a large obstetric hospital delivery room, Hanoi, Vietnam

Tina Dempsey; Huong Thu Nguyen; Huong Lien Nguyen; Xuan Anh Bui; Phuong Thi Thu Pham; Toan K Nguyen; Daniel Helldén; Francesco Cavallin; Daniele Trevisanuto; Susanna Myrnerts Höök; Mats Blennow; Linus Olson; Hien Vu; Anh Duy Nguyen; Tobias Alfvén; Nicolas Pejovic

doi:10.1016/j.resplu.2022.100338

Endotracheal intubation performance at a large obstetric hospital delivery room, Hanoi, Vietnam

Resusc Plus. 2022 Dec 5:12:100338. doi: 10.1016/j.resplu.2022.100338. eCollection 2022 Dec.

Authors

Tina Dempsey^{1

2}, Huong Thu Nguyen³, Huong Lien Nguyen³, Xuan Anh Bui⁴, Phuong Thi Thu Pham³, Toan K Nguyen^{5

6}, Daniel Helldén¹, Francesco Cavallin⁷, Daniele Trevisanuto⁸, Susanna Myrnerts Höök^{1

9}, Mats Blennow¹⁰, Linus Olson^{1

11

12}, Hien Vu^{6

13

14

15}, Anh Duy Nguyen^{15

16}, Tobias Alfvén^{1

9}, Nicolas Pejovic^{1

17}

Affiliations

¹ Department of Global Public Health, Karolinska Institutet, 17177 Solna, Sweden.
² Astrid Lindgren Children's Hospital, Karolinska University Hospital, 17176 Solna, Sweden.
³ Neonatal Department, Phu San Hanoi Hospital, Hanoi 100000, Viet Nam.
⁴ Department of Information Technology, Phu San Hanoi Hospital, Hanoi 100000, Viet Nam.
⁵ Department of Gynecological Oncology, Phu San Hanoi Hospital, Hanoi 100000, Viet Nam.
⁶ Department of International Collaboration, Phu San Hanoi Hospital, Hanoi 100000, Viet Nam.
⁷ Independent Statistician, 36020 Solagna, Italy.
⁸ Department of Woman's and Child's Health, University Hospital of Padova, 35128 Padova, Italy.
⁹ Emergency Care Unit, Sachs' Children and Youth Hospital, 11883 Stockholm, Sweden.
¹⁰ Department of Clinical Science Intervention and Technology, Karolinska Institutet, 14152 Huddinge, Sweden.
¹¹ Department of Women's and Children's Health, Karolinska Institutet, 17177 Solna, Sweden.
¹² Department of Medical Biochemistry and Microbiology, Uppsala University, 75237 Uppsala, Sweden.
¹³ Intensive Care Unit and Poison Control Department, Phu San Hanoi Hospital, Hanoi 100000, Viet Nam.
¹⁴ Social Work Department, Phu San Hanoi Hospital, Hanoi 100000, Viet Nam.
¹⁵ University of Medicine and Pharmacy, Hanoi 100000, Viet Nam.
¹⁶ Board of Directors, Phu San Hanoi Hospital, Hanoi 100000, Viet Nam.
¹⁷ Neonatal Unit, Sachs' Children and Youth Hospital, 11883 Stockholm, Sweden.

Abstract

Introduction: Intrapartum-related events account for nearly 700,000 neonatal deaths globally yearly. Endotracheal intubation is a cornerstone in preventing many of these deaths, but it is a difficult skill to acquire. Previous studies have described intubation performances in high-income countries, but data from low- and middle-income countries are lacking. We aimed to assess the performance of delivery room intubation in a lower middle-income country.

Methods: This prospective observational study was conducted at the Phu San Hanoi Hospital, Vietnam, from September 2020 to January 2021. Video cameras were positioned above the resuscitation tables and data were extracted using adopted software (NeoTapAS). All neonates requiring positive pressure ventilation were included. Our main variables of interest were time to first intubation attempt, first intubation attempt duration, and successful first intubation attempt.

Results: 18,107 neonates were born during the five months. Of these, 75 (0.4%) received positive pressure ventilation, and 36 (0.2%) required endotracheal intubation of whom 24 were captured on video. The median time to the first intubation attempt was 252 seconds (range 91-771 seconds), the median first attempt duration was 49 seconds (range 10-105 seconds), and the first attempt success rate was 75%.

Conclusion: Incidences of positive pressure ventilation and endotracheal intubation were low in comparison to global estimates. Three out of four intubations were successful at the first attempt and the procedural duration was often longer than recommended. Future studies should focus on how to achieve and maintain intubation skills and could include considering alternative devices for airway management at birth.

Keywords: Birth asphyxia; ETI, Endotracheal tube intubation; Endotracheal intubation (ETI); FMV, Face mask ventilation; ILCOR, International Liaison Committee on Resuscitation; Intrapartum-related events; Neonatal resuscitation; PPV, Positive pressure ventilation; Positive pressure ventilation (PPV); Vietnam.