Page 37 - JSOM Summer 2025

TABLE 2 Select Quotes Lifted from the End-User Feedback procedure clinically, where time is a major limiting factor due
Assessments in Favor of the Device to desaturation. Second, we are unable to replicate the secre-
… Exchangeable blade would be the absolute game changer tions and bodily fluids in the airway that we will experience
here. Being able to switch out standard for hyperangulated blade, clinically compared to the simulation setting.
different sizes would make me prefer this device over others…
… Geometry closer to a standard Mac blade… Based on these two studies, we believe that an optimal device
… portability, ease of set up, packaging was good selection process may occur in reverse—with robust surveys and
would want this rather than nothing in deployed setting/ qualitative feedback on all potentially feasible devices, followed
environment setting by a clinical study validating the use of the device. We recently
Portability, Weight, Ease of opening and use completed an unrelated airway study, employing qualitative
Portability, Simplicity of machine, Common sense-nature of use methods (including thematic analysis and surveys) to down-
select supraglottic airway devices for medics to carry in their aid
TABLE 3 Select Quotes Lifted from the End-user Feedback bags. We believe that this method can be applied to selecting
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Assessments Not in Favor of the Device the optimal VL device for the military to field in the deployed
It is fine as a device, but I prefer the glide scope geometry and video setting. Furthermore, some of the newer devices use smartphone
screen, c-mac would be my second choice and i-view last choice. technology, including device connections to the phone, which
The resolution is not as good as the C MAC The brightness is not may further enhance screen resolution while reducing costs.
as good as the C MAC. The size of the screen is different and could However, these devices may not be compatible with the security
be a bit bigger. requirements of future conflicts given the electromagnetic signal
It feels slightly more difficult to perform DL with the i-view. A less 31
angulated blade may help in those situations where video is difficult they emit.
secondary to blood or copious secretions. A slightly larger screen
couldn’t hurt, but the current size is adequate. Exchangeable blade Our study has several limitations to highlight. First, the survey
would be the absolute game changer here. Being able to switch out participants knew we had to stop the clinical trial early due to
standard for hyperangulated blade, different sizes would make me the i-view’s poor clinical performance; this may have biased
prefer this device over others. their answers. Second, survey administration occurred after
Issues with fogging of camera, better screen resolution, brighter the study’s completion, and therefore, there may be recall bias.
screen Third, our survey only underwent face validation. Serial itera-
Thickness/strength of blade (too thick), Angulation, thickness
affected back up use of direct laryngoscope, screen resolution tions of the survey may have elucidated further detail. Fourth,
Video is either crappy resolution, or too small. I honestly couldn’t only one of our two clinical sites included military physicians;
tell. I never accidently hit the power button, but it needs to be in a thus, we have limited feedback from military personnel best
less accident prone area. suited to assess the suitability of the technology for use in a
Resolution is poor especially once device enters mouth/moist deployed setting. Lastly, all of the intubations were performed
environment. Not bright enough once in mouth. I wish the video by physician trainees, so the application to physician assistants
box angle was adjustable left, right, up, and down. and nurse practitioners may be limited.

associated with significant morbidity and mortality. The
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risk of adverse outcomes rises with the number of attempts Conclusion
required to cannulate the airway successfully. Consequently, Our survey highlighted multiple issues with the i-view device
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first-pass success has become a surrogate measure for effec- in clinical settings. Our findings will inform device develop-
tive airway management. 23–27 Our clinical study of the i-view ment and modification for prehospital deployed use.
demonstrated inferior first-pass success compared to standard
video laryngoscopy. This study employed qualitative research Author Contribtions
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methods to elucidate the reasons behind this finding. SGS, JKM, MDA, and VSB were involved in the grant appli-
cation. SGS, AAA, BJL, WTD, JKM, MDA, AAG, and VSB
In this study, we surveyed 100% of the emergency physicians developed and obtained regulatory approvals. SGS and DRA
who used the i-view device during our clinical trial. The lowest- served as the primary site investigators. JM was the primary
scoring areas related to the device focused on screen resolution research coordinator involved in prospective data collection,
and brightness. Upon further investigation with the thematic regulatory management, and data verification. AAA was the
analysis, this appears to be related to the inability to see the study statistician. SGS drafted the manuscript, with all other
video clearly (especially once the camera is device to secretions authors providing critical revisions. All authors contributed
and vomit) and issues with angulation, resulting in a lower substantially to the research study. SGS is the study and grant
first-pass success. principal investigator and accepts responsibility for all aspects
of the study.
The follow-on survey aimed to inform device selection for de-
ployed use and potentially modify currently marketed device Disclosures
for the deployed setting. This survey study highlighted the lim- SGS, BJL, DRA, MDA, JKM, AAA, and VSB have all received
itations in conducting a clinical trial to find the best device, funding from the Department of Defense in the form of grants
as repetitive clinical trials become expensive, whereas surveys to their institutions. AAA and VSB have received funding from
are much less expensive. Through the combination of these the National Institutes of Health in the form of grants to their
studies (survey and clinical trial), we found that a device that institutions. We have no other conflicts of interest to report.
showed promise during simulation testing did not translate to
success in the clinical setting. 17,28,29 The reason for this is likely Disclaimer
multifactorial. First, in the simulation setting, we are unable The views expressed in this article are those of the authors and
to reproduce the anxiety that occurs when performing the do not reflect the official policy or position of the U.S. Army

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