The Efficacy of a Standard Training Program for Transillumination–guided Endotracheal Intubation

Objective: To evaluate the success rate, intubation time, and complication rate of transillumination–guided intubation following two hours of instruction in the use of the Trachlight (TL) device.
Methods: A prospective, randomized crossover laboratory trial was conducted at an emergency medical service training site with 30 nonpaid volunteer paramedic students, one month prior to their graduation. The students were instructed in the use of the TL in a standardized curriculum consisting of didactic, video, and demonstration sessions. Each student was required to successfully intubate a training manikin with the TL five times. Approximately three weeks later, the students were asked to intubate the manikin 20 times, alternating between direct laryngoscopy (DL) and TL.
Results: The success rates were 94% for DL and 63% for TL (p < 0.0001). The mean intubation times were 14.6 seconds for DL and 16.8 seconds for TL (p < 0.001). The incidences of trauma were 7.3% for DL and 1.4% for TL (p < 0.001).
Conclusion: A two–hour training session, including five successful light–guided intubations using the TL, was inadequate for producing acceptable success rates during manikin intubations by paramedic students. While TL intubation intervals were shorter when successful, the 2.2–second difference was not clinically meaningful. The incidence of trauma in our manikin model during TL intubations was significantly lower than that with DL.