Page 35 - JSOM Summer 2025

An End-user Assessment of the
Novel i-view Video Laryngoscope After a Clinical Trial

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Steven G. Schauer, DO, MS *; Brit J. Long, MD ; Daniel Resnick-Ault, MD ;
Michael D. April, MD, DPhil, MSc ; Jessica Mendez, MS ; Allyson A. Arana, PhD ;
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Joseph K. Maddry, MD ; Adit A. Ginde, MD, MPH ; Vikhyat S. Bebarta, MD 9
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ABSTRACT
Introduction: Airway obstruction is a leading cause of poten- after-action review data suggest that much of the challenges
tially survivable death on the battlefield. Intubation remains surrounding intubation in locations such as the battalion aid
the most frequently performed prehospital airway interven- station are related to training and lack of technology, including
tion. Unfortunately, survival is lower after prehospital intu- video technology. 11–13 As a point of reference, the U.S. Military
bation compared to the emergency department. After-action previously fielded the GlideScope at a cost of $12,292.67 for
review data suggest that forward-staged technology is lack- each (National Supply Number 6515-01-572-7262). The cur-
ing. Additionally, video laryngoscopy (VL) is superior to di- rently fielded GlideScope device is no longer being manufac-
rect laryngoscopy, especially in the hands of novice intubators. tured, and the military needs a replacement device for fielding.
The i-view is a novel, inexpensive, handheld VL device that
showed promise in far-forward areas. However, our clinical The i-view (Figure 1) is a novel single-use VL device produced
study demonstrated inferior clinical performance of the i-view by Intersurgical (Wokingham, United Kingdom) that costs ap-
compared to our current standard devices in first-pass success. proximately US$100–200 each. This device is handheld with
This study used feedback from intubating operators to identify a built-in screen and a blade that generally mirrors a standard
potential causes of this substandard performance. Methods: geometry blade. This technology is potentially advantageous
We conducted a prospective survey of intubating operators us- to the U.S. Military as it does not require ongoing maintenance
ing the novel video device as part of a clinical trial. We sought and is cost-friendly for wide dispersion. Thus, it may fill the
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their feedback using a Likert scale survey and free text feed- gap in needed technology in these forward-staged areas. The
back. The study team reviewed the free text feedback using a low cost makes it an attractive tool for the civilian prehospital
thematic analysis method. Results: We surveyed 31 emergency setting, where it would not be cost-effective to place many VL
physicians who had used the device (30 fully completed sur- systems in each EMS vehicle. 15,16
veys and one partially completed). The lowest-scoring areas
were screen brightness, with a median score of 2 (IQR 2–4), Given these findings, we conducted a prospective, quasi-
and screen resolution, with a median score of 2 (1–4), indicat- experimental clinical trial in the emergency department (ED)
ing that these were the major performance challenges. The- at two level I trauma centers to assess whether this device has
matic analysis suggested that the i-view’s primary challenges adequate clinical performance characteristics. We initially per-
were screen brightness, resolution, visibility through bodily formed simulation testing prior to the clinical trial, which was
fluids, and fogging. Conclusions: Our survey highlighted mul- promising. However, during a clinical trial in which patients
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tiple issues with i-view’s use. Our findings will inform device were prospectively assigned devices for intubation in the ED,
development and modification for prehospital deployed use. we found inferior first-pass success with the i-view device.
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We performed an unplanned interim analysis after receiving
Keywords: airway; i-view; video; laryngoscopy; laryngoscope; negative feedback from the end-users and stopped the clini-
military; trauma; intubation cal trial early due to the futility of reaching our noninferiority
endpoint. Given the informal feedback received, we sought
to perform a prospective follow-on study formally assessing
operator feedback to inform technology development for the
Introduction
Role 1 deployed setting.
Video laryngoscopy (VL) has changed intubation methodology,
especially in the emergency setting. Current data suggest that VL Methods
is superior to direct laryngoscopy (DL), especially in the hands
of novice intubators. Current VL technology is cost-prohib- Participants and Setting
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itive for dispersion around the battlespace, yet many of the in- We conducted our study in parallel at two sites—the Brooke
tubators in far-forward areas are relatively novice. 8–10 Previous Army Medical Center (BAMC) and the Colorado University
*Correspondence to steven.g.schauer.mil@army.mil
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1 LTC Steven G. Schauer and Jessica Mendez are affiliated with the U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, TX.
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1 LTC Steven G. Schauer, Maj Brit J. Long, LTC Michael D. April and Col Joseph K. Maddry are affiliated with Brooke Army Medical Center,
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JBSA Fort Sam Houston, TX. LTC Michael D. April, and Col Joseph K. Maddry are affiliated with the Uniformed Service University of the Health
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Sciences, Bethesda, MD. Maj Brit J. Long, Dr. Adit A Ginde, and Col Vikhyat S. Bebarta are affiliated with the University of Colorado School of
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Medicine, Aurora, CO. Dr. Allyson A. Arana and Col Joseph K. Maddry are affiliated with the 59th Medical Wing, JBSA, Lackland, TX.
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