Usability testing of a blind intubation device for intubation novices: a randomized crossover simulation study

Area of Science:

• Medical Devices
• Anesthesiology
• Emergency Medicine
• Airway Management

Background:

• Endotracheal intubation is a critical procedure in emergency and critical care settings.
• Direct laryngoscopy (DL) and video laryngoscopy (VL) are common methods, but their success rates can vary, especially with inexperienced providers.
• A novel blind intubation device (BID) has been developed to potentially improve intubation outcomes.

Purpose of the Study:

• To evaluate the usability of a new blind intubation device (BID).
• To compare the performance of the BID against direct laryngoscopy (DL) and video laryngoscopy (VL) in inexperienced healthcare providers.
• To assess key metrics including first-pass intubation success, time to ventilation, and incidence of dental injury.

Main Methods:

• A randomized crossover simulation study was conducted with 45 novice healthcare providers (physicians, EMTs, nurses) with fewer than five live intubation experiences.
• Participants performed endotracheal intubation using a manikin with DL, VL, and the new BID.
• Primary outcome: first-pass intubation success rate. Secondary outcome: time to first ventilation. Tertiary outcome: dental injury.

Main Results:

• First-pass intubation success rates were high and not significantly different across devices: BID (93.3%), DL (91.1%), and VL (97.8%).
• Intubation time to first ventilation was significantly shorter with the BID (13.15±6.16 seconds) compared to DL (19.07±7.71 seconds) and VL (17.31±6.57 seconds) (P<0.01).
• Dental injury rates varied by provider type and device, with the BID showing 0% injury in physicians, but notable rates in EMTs and nurses, though lower than DL in nurses.

Conclusions:

• The pilot study indicates that the new blind intubation device (BID) is a viable option for endotracheal intubation among inexperienced providers.
• The BID achieved success rates comparable to DL and VL, with a statistically significant reduction in the time required for intubation.
• Further research is warranted to fully elucidate the BID's role in diverse clinical scenarios and its long-term impact on patient safety and provider training.