Our pilot study investigated whether two anaesthetists could generate concordant VCI scores in real-time for a given patient undergoing elective airway surgery. We found that two anaesthetists produced identical VCI scores in 34 out of 35 patients.
The VCI project aims to assess the usability and reproducibility of the VCI score in various patient groups and clinical settings. This is an open invitation for interested parties to help determine whether the VCI score works in the real world. We propose a multi-centre service evaluation gathering data from as many tracheal intubations using videolaryngoscopy as possible. For each tracheal intubation using videolaryngoscopy, we invite the intubator and an observer to submit a VCI score. We will then assess agreement between each pair of scores. The only proposed difference to usual care of patients is the documentation of the intubation. We hope that this will enable patient groups such as the critically ill, paediatric and obstetric patients to be included.
Investigating the reliability of the VCI score is an exciting project. For the first time, a videolaryngoscopy score is being evaluated across several clinical settings in the real world outside the confines of mannequins and the anaesthetic room. Participating will enable an essential piece of work to be completed on the usability and reproducibility of a clinical tool that will hopefully enable improved patient safety by allowing practical and concise communication tracheal intubation using videolaryngoscopy.
By taking part in this project, you will be recognised as a collaborator on publications of work related to the VCI project and will receive a certificate acknowledging your contribution for your portfolio.
Volunteer to be a local lead registers their intention to apply for service evaluation approval at their organisation
Local lead secures local clinical governance approval for their site to conduct this service evaluation
Local lead facilitates the registration of local investigators/data contributors to the VCI Project
Locally agreed data collection submitted through the VCI Project Submission Form within 6-12 month project window
Data analysis by the VCI Project Team
Project Team aims to produce a preliminary report within 6 months of data collection being complete
Any healthcare professional can be a local lead at their organisation and you can register your intent to be a local lead here. A named consultant may be required to support organisational involvement in the VCI Project and may be able to delegate the role of local lead to someone else.
Once your organisation has local service evaluation approval, anyone working at this organisation can submit data once they have registered to be a data contributor/local investigator. A list of enrolled organisations is available can be found here.
In order to participate in the VCI Project, it is essential that the project is locally registered with the clinical governance department as a service evaluation project. A named consultant may need to support local involvement in the VCI Project (and can delegate the role of local lead to someone else). You can find details that are frequently requested on service evaluation application forms below – feel free to copy and paste appropriate details.
Project aim : To assess the usability and reproducibility of the Video Classification of Intubation (VCI) score.
Service evaluation question: Can two airway-trained individuals produce congruent VCI scores for a given tracheal intubation using videolaryngoscopy.
Background information: A healthcare professional may place a breathing tube (known as a tracheal tube) into the windpipe (known as the trachea). This procedure is known as tracheal intubation. This allows a breathing machine (known as a ventilator) to move oxygen in and out of the lungs. Instruments called videolaryngoscopes are used to aid insertion of the tracheal tube. Videolaryngoscopes are able to look around the corner of the soft tissues in the mouth and transmit a video image of the tracheal opening to a screen. Obtaining a view of the tracheal opening on the screen does not necessarily indicate the ease with which the tracheal tube can be passed around the back of the mouth. At present there is no universally accepted method available for describing tracheal intubation using videolaryngoscopy. It is important that this information is accurately communicated and documented to plan procedures related to the airway management of that patient. The Video Classification of Intubation (VCI) Score has been proposed to succinctly describe the key practically useful elements of tracheal intubation using videolaryngoscopy in the order in which they are performed.
Protocol: One airway trained individual carries out tracheal intubation using videolaryngoscopy as part of standard care of the patient and produces a VCI score based on this. A second airway trained individual observes this procedure and records an independent VCI score. It is important to note that the patient will not be subjected to any additional procedure by taking part in this project – the only proposed difference to usual care is the documentation of this procedure.
Data points to be collected: [No patient identifiable information will be collected] Date of tracheal intubation using videolaryngoscopy; Age of patient (years); Gender (M/F/other); Do you consider the patient to be morbidly obese (BMI >40) (yes/no); Where did the tracheal intubation occur (theatre suite, emergency department, critical care unit, pre-hospital, obstetric unit, other); What was the primary indication for tracheal intubation (general anaesthetic for diagnostic/therapeutic procedure, airway protection, respiratory failure, multi-organ failure, cardiac arrest, other); What videolaryngoscopy device was used?; Intubator – job title and grade; Observer – job title and grade; VCI score – intubator; VCI score – observer
Adverse events: Adverse events related to tracheal intubation will be related to those occurring during standard care and should be actioned in the appropriate manner at the time. It is important to note that the patient will not be subjected to any additional procedure by taking part in this project – the only proposed difference to usual care is the documentation of this procedure.
Data collection: Registered local invetigators will be able to upload their data via a unique log-in onto a secure, custom built web-based platform (www.vciscore.com).
Data management: The data collection spreadsheet will be kept on a password protected secure web-based database and will only be accessible by the Project Team. The data will be stored for the duration of the service evaluation and until the work has been disseminated. The service evaluation will comply with GDPR 2018 with regards to the collection, storage, processing and disclosure of personal information and will uphold the Act’s core principles. The data custodian is Dr Rajinder Chaggar (rajinderschaggar@nhs.net).
Service evaluation approval needs to be obtained at each site participating in the project since the project involves collecting (anonymous) patient data.
Ethical approval is not required because patients will not be subjected to any additional procedure as a result of being included in this project – the only proposed difference to the usual care the patient will receive is the clinician’s documentation of tracheal intubation using videolaryngoscopy.
We have chosen a pragmatic methodology for this multi-centre service evaluation since instrumenting a patient’s airway twice to generate two separate and strictly independent 3-part VCI scores would be associated with an unacceptable risk of airway trauma.