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Rev Bras Anestesiol. 2009 May-Jun;59(3):321-31.

Using the Cusum curve to evaluate the training of orotracheal intubation with the Truview EVO2 laryngoscope.

[Article in English, Portuguese]

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Laboratório Experimental de Vias Aéreas e Pulmões do Centro de Pesquisas do Hospital de Clínicas de Porto Alegre (HCPA/ UFRGS) - Serviço de Pneumologia, Porto Alegre, RS.



Learning curves have proved to be useful tools to monitor the performance of a worker on a new assignment. Those curves have been used to evaluate several medical procedures. The objective of this study was to evaluate the learning of orotracheal intubation (OTI) with the Truview EVO2 laryngoscope with the CUSUM learning curve.


Four trainees underwent OTI training with the Truview EVO2 laryngoscope in a mannequin. They received orientation on the successful and failure criteria of OTI and alternated during the attempts, for a total of 300 OTI for each one. Four learning curves were plotted using the CUSUM cumulative addition method.


It was calculated that the 105 OTIs were necessary to achieve proficiency. The four trainees crossed the line of acceptable failure rate of 5% before completing 105 OTIs; the first trainee reached proficiency after 42 OTIs, the second and third after 56 OTIs, and the fourth after 97 OTIs, and from then on their performance remained constant. Differences in the success rate between residents and experienced anesthesiologists were not observed.


The CUSUM learning curve is a useful instrument to demonstrate objectively the ability when performing a new task. Laryngoscopy with the Truview EVO2 in a mannequin proved to be an easy procedure for physicians with prior experience in OTI; however, one should be cautious when transposing those results to clinical practice.

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