A. N. Bowder2, R. Amin1, L. McCormick3, S. Siddiqui1,3 1Children’s Hospital Of Wisconsin,Pediatric Surgery,Milwaukee, WI, USA 2Medical College Of Wisconsin,General Surgery,Milwaukee, WI, USA 3Brio Device,Ann Arbor, MICHIGAN, USA
Introduction: There is a paucity of anesthesia providers worldwide. This severe shortage in the global surgery workforce has left billions of people without access to surgical care. A recent study by the World Federation of Societies of Anesthesiologists surveyed 153 countries and found there to be a limited number of physician anesthesia providers (PAP) in low and middle-income countries (LMICs). In the African and South East Asian Regions alone, there are on average 1.36 and 1.20 PAP. The global community continues to search for innovative solutions aimed at safely decreasing the discrepancy between anesthesia providers and the burden of surgical disease. We propose that the creation of an intuitive and safe intubation tool could be integral to increasing the anesthesia workforce globally.
Methods: We performed an IRB-approved single center prospective comparison of mannequin intubation by medical students using an articulating video stylet (AVS) and the Olympus bronchoscope. The device used first was alternated between consecutive participants to account for any learning effect. Five successful intubations were completed with each device. Time to intubation was measured from when the participant picked up the instrument until the tip had passed beyond the vocal cords. The number of passes to successful intubation was also recorded.
Results:A total of 19 participants were recruited. The learning curve was noted to be less steep with the AVS (Table1). Intubation time was significantly shorter with use of the AVS. The mean intubation time for the AVS was on average 25.2 seconds less than for the bronchoscope (P<0.0001). Additionally, more than one attempt were only required in 6% of the intubations using AVS compared to 18% with the bronchoscope (P=0.0057).
Conclusions:This study demonstrates the feasibility of creating an intubation device with little to no learning curve when performed in a standardized mannequin. These results merit continued development. We also will need to complete larger research trials aimed at validating our findings and evaluating the clinical safety of this device. If we are able to prove that the AVS is able to safely, decrease the learning curve in the clinical setting it has the potential to address the shortage of anesthesia providers promptly. Over fifty percent of countries surveyed reported 4 or more years of training required for a PAP. If we are able to decrease this training time even slightly we can make great strides towards reducing the overall burden of surgical disease. Furthermore, this innovative technology can be used by the global community as they develop sustainable task shifting models for non-physician anesthesia provide in LMICs
