Airway management in pre-hospital and combat care is inadequate, particularly with trauma. Video enhanced visualization improves intubation success rates based on studies using video laryngoscopy, particularly in difficult airways. Video enabled supraglottic placement of the LMA and adjunctive devices may improve the success rates of airway rescue for combat and civilian trauma victims. Telemedicine with video devices can improve pre-hospital care if adequate bandwidth is available. Our objective has four elements:
- Design, develop, and test a video enabled intubating LMA and accessories. These accessories will include robotic decision diagnosis and treatment algorithms which will guide perioperative care, interface with a preoperative record and facilitate the performance of quality control monitoring and best practices improvement in the perioperative process.
- Design, develop, and test a novel intubating video stylet and accessories
- Analyze, design, and test local area network (LAN) wireless video transmission for video laryngoscopy to improve utility in constrained spaces and pre-hospital locations
- Analyze, design, and test wide area network (WAN) wireless video transmission for video-enabled airway management devices for telemedicine applications.
Specific Aims: We seek to design develop and test prototype video-enabled airway devices and network topology to allow remotely located providers to participate in airway management using telemedicine
1) Establishment of a Teleanesthesiology Service between the Omaha VA NWIHCS, WRAMC and Satellite Clinics;
2) Initiation of a Village Health Worker Training Program to Reduce the Need for US Military Medical Assets in Afghanistan;
3) Development of a Proof of Concept of a Joint VA DOD Perioperative Telemedicine Clinic;
4) Establishment of a Telepsychiatry Center for Wounded Warriors at the University of Nebraska;
5) Development of Battlefield Airway Management for Wounded Warriors: Safe Airway Access in Combat;
6) Battlefield Android Telemedicine System;
7) Battlefield Tracheal Intubation Training Using Virtual Simulation: A Multi Center Operational Utility Evaluation (OUE) of Video Laryngoscope Technology;
8) Airway Management Training for Medical Students
Projects presented at the American Society of Anesthesiology meeting in Washington, DC in October, 2012:
- Endotracheal Intubation with a Traditional Video Laryngoscope Blade versus an Integrated Suction Blade in a Hemorrhagic Airway Cadaver Model
- A Demonstration of the Storz C-CAM in Endoscopic Imagery Projection for Far Forward Battlefield Telemetric Support.
- Description of a Novel Device (C-HUB™) to Link the Karl Storz Video Laryngoscope to a Telemedicine Monitor for Far Forward Battlefield Support
- Using the Intubating Laryngeal Tube in a Manikin – User Evaluation of a New Airway Device.
- Demonstration of Distance Training of a Complex Medical Task Using Adobe Connect
- Advanced Medical Technology Capacity Building: A Unique Application of SOF Counterinsurgency Medical Seminars Medical Programs.
- Use of a Cardiac Algorithm in a Preoperative Evaluation Clinic- A Pilot Study.
- Performance Comparison of Laryngoscopy and Suction Techniques in a Hemorrhagic Airway Manikin Simulator: Direct Laryngoscopy with Yankauer vs. Storz C-MAC with attached Suction Tip.
- Virtual Intubation Training at a Remote Military Site
- A Comparison of Direct versus Indirect Laryngoscopy during Endotracheal Intubation of Lightly Embalmed Cadavers utilizing the GlideScope, Storz Medi Pack Mobile Imaging System and the Storz C-MAC Video Laryngoscopes.
- Demonstration of Novel Method for Nasal Intubation Using Video Laryngoscopy: An Intubation Bougie and Curved Intubating Forceps.