Document Type

Dissertation

Degree

Doctor of Nursing Practice

Major

Nursing

Date of Defense

11-19-2025

Graduate Advisor

Jinnie Tkach

Co-Advisor

Kimberly Werner

Committee

Rebecca Chambers

Abstract

Abstract

Problem: Airway management is the primary intervention for halting clinical decompensation in pediatric and neonatal patients. In cases where patients require invasive support, endotracheal intubation (ETI) is the preferred method of airway securement. Unfortunately, ETI is a challenging skill to develop, especially when caring for children and infants, resulting in increased rates of failed ETI attempts which can result in worse outcomes. ETI success rates in the population of interest have fallen in recent years, nationally and among the clinicians in this project. The institution established a goal for first pass success (FPS) and video laryngoscope (VL) was introduced to support this goal.

Methods: This program evaluation utilizes retrospective chart review to assess the impact of access to a VL has on device use patterns and clinical outcomes, FPS and definitive airway sans hypoxia/hypotension on the first attempt (DASH 1A), among pediatric and neonatal transport clinicians.

Results: Following the implementation of VL access, the use of the device among clinicians was limited (n = 9) resulting in no significant differences between the preintervention and postintervention groups. Subgroup analysis resulted in a statistically significance difference between DL and VL for DASH 1A (t (16) = 1.455, p = .082) when α = .10, favoring VL; FPS (t (16) = .970, p = .173) showed trends in favor of VL. Risk estimates also favor VL; FPS (OR = 2.800, 95% CI [.361, 21.727], p < 0.05), and DASH 1A (OR = 4.375, 95% CI [.564, 33.949], p < 0.05). Overall success rate for FPS (DL 55.6%, VL 77.8%) and DASH 1A (DL 44.4%, VL 77.8%) favored VL.

Implications for Practice: VL is a resource that may improve FPS and DASH 1A rates among transport team clinicians at the institution studied in this project. VL presents several benefits when compared to DL including fewer complications, improved FPS and DASH 1A success, and training supervision. Supporting interventions, training bundles and documentation, may improve data collection and encourage use of VL. Ongoing evaluation of VL use and the target outcomes should be continued to guide clinical practice and support the goals of the institution.

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