Video Laryngoscopes in Simulated Neonatal Intubation: Usability Study

<b>Background/Objectives</b>: Neonatal intubation is a complex procedure, often associated with low first-pass success rates and a high incidence of complications. Video laryngoscopes provide several advantages, including higher success rates, especially for novice clinicians, a magnified airway view that can be shared with supervisors, and the ability to record still or video images for debriefing and education. However, video laryngoscope devices vary, raising the possibility of differences in usability. <b>Methods</b>: The study used mixed methodology, including observations, semi-structured interviews, think-aloud techniques, high-fidelity simulations, function tests, and questionnaires to assess usability, defined by the clinician satisfaction, efficacy, and efficiency of six video laryngoscope devices; (1) C-MAC^® with Miller blade, (2) GlideScope^® Core^TM with Miller blade, (3) GlideScope^® Core^TM with hyperangle LoPro blade, (4) Koala^® Vision Ultra with Miller blade, (5) Koala^® Handheld with Miller blade, and (6) Parker Neonatal with Miller blade. Clinician satisfaction was determined by the System Usability Scale (SUS), National Aeronautics and Space Administration Task Load Index (NASA-TLX), and clinician preference. Device efficacy was determined by first-pass success, number of attempts, and overall success. Efficiency was assessed by time to successful intubation and function test completion rates. <b>Results</b>: Neonatal video laryngoscopes varied considerably in design, impacting usability. All devices were deemed suitable for neonatal intubation, with the Koala^® Handheld, C-MAC^®, and GlideScope^® Core ^TM Miller demonstrating the highest usability. <b>Conclusions</b>: This simulation-based study highlights substantial variability in neonatal video laryngoscope usability, indicating the need for further research into usability in the clinical setting.