Page 28 - JSOM Winter 2021

A Prospective, Feasibility Assessment of a Novel,

Disposable Video Laryngoscope With Special Operations
Medical Personnel in a Mobile Helicopter Simulation Setting

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Steven G. Schauer, DO, MS *; Jessica Mendez, BS ;
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Nguvan Uhaa, LVN ; Ian L. Hudson, DO, MPH ; Wells L. Weymouth, MD 5

ABSTRACT
Background: Video laryngoscopy (VL) is shown to improve (72–89%) in several studies, which is most pronounced in the
first-pass success rates and decrease complications in intuba- prehospital setting. 4–6
tions, especially in novice proceduralists. However, the cur-
rently fielded VL devices are cost-prohibitive for dispersion The widespread use of VL in the early 2000s offered a new
across the battlespace. The novel i-view VL is a low-cost, intubation modality. This was put in place to address this crit-
disposable VL device that may serve as a potential solution. ical capability gap to reduce complications, including better
We sought to perform end-user performance testing and so- first-pass success. VL allows the operator to view the airway
licit feedback. Methods: We prospectively enrolled Special anatomy indirectly through a camera that projects onto a
Operations flight medics with the 160th Special Operations monitor. Observational evidence suggests that first attempt
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Aviation Regiment at Hunter Army Airfield, Savannah, Geor- ETI success is higher with VL compared to direct laryngoscopy
gia. We asked them to perform an intubation using a synthetic (DL), which is particularly noted among operators with less
cadaver model while in a mobile helicopter simulation setting. airway management experience. Many of the military end us-
We surveyed their feedback afterward. Results: The median ers share this characteristic such as Special Operations medics
age of participants was 30 and all were male. Of those, 60% that may be intubating at or near the POI, including en route
reported previous combat deployments, with a median of 20 to forward stage resuscitation teams. 9,10 Special Operations
months of deployment time. Of the 10, 90% were successful combat medics and flight paramedics are unique compared the
with intubation, with 60% on first-pass success with an aver- basic 68W combat medic in their training specific to ETI. This
age of 83 seconds time to intubation. Most had a grade 1 view. is because they undergo the Special Operations Combat Medic
Most agreed or strongly agreed that it was easy to use (70%), Course, which trains in advanced procedures and enables them
with half (50%) reporting they would use it in the deployed to sustain a casualty for up to 72 hours. That course includes
setting. Several made comments about the screen not being approximately 21.5 hours of ETI training (1.5 hours didactic,
bright enough and would prefer one with a rotating display. 20 hours practice course, personal communication with COL
Conclusions: We found a high proportion of success for intu- Cord Cunningham, previous program director).
bation in the mobile simulator and a high satisfaction rate for
this device by Special Operations Forces medics. VL offers a potential benefit for improved airway management
in these settings, particularly flight personnel where procedures
Keywords: i-view; medic; airway; intubation; flight; helicopter; have the additional technical challenges of performing them
laryngoscopy during transport. Supplying all Role 1 and 2 facilities with VL
equipment commonly used in US emergency departments, such
as the currently fielded Glidescope (Verathon; www.verathon

.com/glidescope), is not logistically possible due to the cost of
Introduction
the device, power supply requirements, and periodic mainte-
Airway compromise is the second leading cause of prevent- nance/repairs of this equipment at far forward locations. The
able death in the prehospital setting. Endotracheal intuba- US Army currently fields the Glidescopes to the forward surgi-
1,2
tion (ETI) is a crucial skill for prehospital medical personnel, cal teams and the emergency/operating rooms of Combat Sup-
especially during the Role 1 phase of care, in which critical port Hospitals (with conversion into the new Field Hospital
interventions are likely to have the largest impact. Part of the model) at a cost of $12,292.67 each (National Supply Number
Role 1 phase of care includes the initial transport of casual- 6515-01-572-7262). A new disposable, single-use video laryn-
ties from the point-of-injury (POI) to a battalion aid station goscope is on the market – the i-view ( Intersurgical; https://
or forward-staged surgical teams. Airway management is the us.intersurgical.com/info/iview) – at a cost of approximately
first priority in the hospital setting in trauma patients who are $100–$200 per unit (Figure 1). Given that this single-use device
unable to protect their airway, according to Advanced Trauma does not require maintenance and power sources, the i-view
Life Support guidelines. However, historically, ETI by direct offers a potential opportunity to bring VL technology to Role 1
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laryngoscopy has been hindered by suboptimal success rates and 2 facilities. Furthermore, the i-view as an expendable item
*Correspondence to 3698 Chambers Pass, JBSA Fort Sam Houston, TX 78234; or Steven.G.Schauer.mil@mail.mil
1 MAJ Steven G. Schauer, Jessica Mendez, Nguvan Uhaa, and MAJ Ian L. Hudson are affiliated with the US Army Institute of Surgical Re-
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search, JBSA Fort Sam Houston, TX. MAJ Schauer and MAJ Hudson are also affiliated with the Brooke Army Medical Center, JBSA Fort Sam
Houston. MAJ Schauer is additionally affiliated with the 59th Medical Wing, JBSA Fort Sam Houston, and Uniformed Services University of the
Health Sciences, Bethesda, MD. CPT Wells L. Weymouth is with the 160th Special Operations Aviation Regiment, Hunter Army Airfield, GA.
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