A team of bioengineering students at Rice University in Houston, Texas, have designed a simplified yet high-tech device that makes intubating patients for scheduled or emergency procedures much easier.
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The Gateway to Airway team developed the sleek laryngoscope with Kenneth Hiller, an anaesthesiologist in private practice who was keen to create a device that would allow easier access to images of the throat and larynx, and help to place a breathing tube into the trachea.
The handheld, 3D-printed device contains a miniature wireless camera. Clinicians can use a switch on the comfortable handle to adjust light from an LED near the camera, which feeds high-resolution video to one or multiple monitors.
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Hiller recognised early on that engineering his idea into a true product would require specialised knowledge. ‘Current state-of-the-art devices have limitations,’ Hiller said. ‘Placing an endotracheal tube can be challenging in a significant number of patients’ airways. For years, I’ve mulled over what I’d like in a device that can simplify the process and improve patient safety.’
‘He came to us with something built out of popsicle sticks and a metal tube and said, “This is what I’m working toward, but I don’t know how to build it myself,”’ said Rebecca Franklin, a member of the Gateway to Airway team.
‘He wanted a video laryngoscope that not only had wireless video but also had a better blade profile,’ said another team member, Victoria Kong. ‘There are two main types of laryngoscopes: with straight blades and with curved blades, and all the video laryngoscopes on the market are in the curved-blade format. While that’s great for compressing the tongue to get it out of the way, it has a very high displacement volume. It takes up a lot of room in the mouth.
‘That makes it very difficult for the physician to insert the endotracheal tube to give the patient air,’ she continued. ‘The straight blade gives you a more direct line of sight. We wanted to combine the stabilisation afforded by curved blades and a straight-blade profile, and we did that by tapering our blade.’
Hiller also requested a device that would cost less than US$500. ‘That’s within the constraints of our project and overall design, but it’s looking like we can easily get it below US$200,’ said team member Reed Corum. The vacuum-formed, disposable sleeves that cover the blade can be made quickly for pennies, he said.
‘It’s unfortunate that we’re developing this so late in the COVID pandemic, because any procedure that requires intubation requires a laryngoscope as well,’ added team member David Ikejiani.
‘I wasn’t really aware of the impact this could have in the context of COVID-19,’ Kong said. ‘But as we got into it, I realised that this is an important tool to help airway managers minimise contact with potentially contagious aerosolised particles. And the wireless-video capability of our device further creates distance for the safety of the health-care provider.’
Kong noted that all of the video-enabled laryngoscopes on the market require wiring to an external monitor – often a small one on the handle of the device itself. ‘That limits the amount of space and number of people who can be working on the same patient,’ she said.
‘Having the screen attached makes the scope more delicate and harder to transport from room to room,’ Franklin said. ‘Having the video accessible on a tablet means a doctor in another room can watch and give feedback about technique to the airway manager performing the actual procedure.’
The students said that they anticipate that future refinements will include a stainless-steel construction for durability. They also see uses for the device beyond the clinic. ‘EMTs [emergency medical technicians] use their scopes in the field, and we can see expanding to people, for example, in the military who require remote oversight where users may not have expertise gained from years of experience,’ Kong said.
