A novel endotracheal intubation method based on magnetic-guided technology

Abstract

BACKGROUND Endotracheal intubation (ETI) is a crucial skill for airway management in anesthesia and emergency. The classic ETI based on laryngoscopy have limitations in learning curve, respiratory exposure risk and difficult airway. Magnetic-guided technique was based on the non-contact force and has been successfully used in laparoscopy and endoscopy to simplify operation and improve effectiveness. Therefore, we introduce magnetic-guided device of ETI for the first time, developing a magnetic-guided ETI method. METHODS The magnetic-guided ETI device consisted of a magnetic guidewire and an external magnet (EM). For the novel device, the control parameter (working distance) is determined by force and anatomic parameters. The former was investigated by test bench, and the later was measured through CT graph. Then 30 undergraduates without prior ETI training divided into medical and non-medical group according the participant’s major. Both subgroups underwent ETI training with classic and magnetic-guided methods. Magnetic-guided ETI also be tested in difficult airway module. The first-attempt success rate, total intubation time and 5-point Likert scale of difficulty were recorded for assessments. RESULTS We obtained the magnetic force and the tip deflection angle-distance curves of magnetic-guided ETI device. In addition, the surface distance is 32.45 ± 5.24mm, and the deflection angle is 35.4 ± 7.6°. Thus, the working distance for the novel device is 40–60 mm. Magnetic-guided ETI was completed without close and direct exposure to patient’s oral cavity. Compared with classic method, it got a higher first-attempt success rate (magnetic-guided vs classic: 80.0% vs. 66.7%, p<0.05) and less total intubation time (magnetic-guided vs classic: 42.5 ± 2.7s vs 49.4 ± 5.7s, p<0.01) in normal module. In addition, most subjects indicated magnetic-guided ETI is easier than classic method. This is more evident in the Non-medical Group (magnetic-guided vs classic: 2.8 ± 0.8 vs 3.3 ± 0.7, p<0.01). Even in difficult airway, magnetic-guided method still got a higher first-attempt success rate (magnetic-guided vs classic: 73.3% vs 53.3%, p<0.05) and less total intubation time (magnetic-guided vs classic: 45.3 ± 3.7s vs 53.4 ± 3.5s, p<0.01) than classic method. CONCLUSION Magnetic-guided ETI was a simple, safe and effective method. Compared with former work, it is friendlier to non-medical persons and effective for difficult airway. It also avoids direct and close respiratory exposure during operation. The use of the magnetic-guided ETI device can enhance the safety and efficiency of airway management, making it an effective tool for non-medical persons to rapidly perform ETI.