Good practice in airway management highlighted by coronavirus pandemic
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The coronavirus pandemic highlights the importance of good practice in airway management

By Victoria Smith 16 Feb 2021

Sponsored by GSR Technology Europe Sponsored by Visit Company

Before 2020, it was already well acknowledged that video laryngoscopes provide indirect visualisation of a patient’s airway to aid the correct positioning of a tube between the vocal cords and into the trachea. Difficult Airway Society (DAS) guidelines[1] identify the importance of the first attempt at intubation to maximise the possibility of successful intubation at the first attempt or, failing that, to limit the quantity and continuation of tries at laryngoscopy to block airway trauma and progression to a ‘can’t incubate, can’t oxygenate’ (CICO) situation.

The Covid-19 pandemic emphasised the importance of first attempt intubation to efficiently and accurately intubate patients, especially when clinicians are in heightened stress situations.  The pandemic has also raised clinicians’ concerns being in closer proximity to patients during intubation and focusing on approaches that allow for an increased distance between patient and clinician during intubation. Video laryngoscopes provide better glottis views and first-attempt intubation success. In critically ill patients, the importance of first attempt intubation success is even more acute, because an increased number of attempts leads to a greater risk of hypoxia and other life-threatening complications.

airway management

Other hospital departments

However, it isn’t just during the Covid-19 pandemic where video laryngoscopes can affect patient outcomes. In a study conducted by Cook and Kelly and published in the British Journal of Anaesthesia, following an electronic survey sent to all UK NHS hospitals, the availability of video laryngoscopes varied widely across different departments within a hospital. The study reported that 91% of operating theatres had video laryngoscopes available to them. However, this percentage dropped significantly to only 55% in obstetric departments, and down to 35% of emergency departments.  The incidence of difficult or failed intubation increases in the departments where video laryngoscopy is less available.[2] The reason why video laryngoscopy may be used less frequently in these departments in part is likely to be down to finances; the cost implications of a reusable video laryngoscope in low use departments may make it cost-prohibitive. However, a single-use device with a lower unit cost and infrequent use may be a more viable option. In this situation is where the i-viewTM from Intersurgical can lead the way.

airway management

Good practice in airway management: Intersurgical’s i-view

The i-view from Intersurgical is the first single-use, fully disposable, adult video laryngoscope with a Macintosh blade, which provides the option of video laryngoscopy upon the requirement of intubation. The i-view is adaptable for both video and direct laryngoscopy due to a Macintosh blade. The Macintosh blade is more familiar than other types of blade and makes it the ideal device to use in an emergency setting.[3] The ergonomic design ensures the i-view is easy to use and ready to use seconds after being removed from its packaging. The integral TFT-LCD screen, supplied by GSR Technology, provides optimal viewing angles in numerous light conditions. Using the latest light-emitting diode (LED) backlight technology, the display has a high brightness suitable for use in brightly lit environments such as operating rooms. The nature of the i-view laryngoscope means that the screen must be lightweight, which is possible by making the display module as thin as possible, (2.2mm). 

Up-to-date technology for good airway management practice

Video laryngoscopes use the latest display, and full integrated camera cube technology to provide an optimal (indirect) view of the larynx during intubation and the i-view from Intersurgical is no exception. The display is key to the laryngoscope’s visual performance, as is GSR Technology’s state-of-the-art camera cube as part of a flexible printed circuit board (PCB) assembly. The camera selected by GSR Technology and approved by Intersurgical is a complementary metal-oxide-semiconductor (CMOS) image sensor camera cube chip. Using a single chip camera and image processor in a small footprint is pivotal, as is it being capable of being reflow soldered to the FPC to maximise production efficiency.

GSR Technology also supplies a wide viewing angle LED as part of the flexible circuit board (FPC) assembly. The LED enables the image from the camera cube to be visible on the screen. To ensure product continuity, GSR Technology purchases from specific colour and brightness bin grades so that there is no discernible difference in performance from one product to another.

GSR Technology Europe supplies the TFT display and FPC assembly for final assembly into the i-view laryngoscope at Intersurgical’s state-of-the-art manufacturing facility in Wokingham, UK, ready for global distribution.

Infection control

The Association of Anaesthetists of Great Britain and Ireland (AAGBI) confirmed in their safety guideline booklet of 2008 that concerning standard laryngoscopes ‘Current practices for decontamination and disinfection between patients are frequently ineffective, leaving residual contamination implicated as a source of cross-infection.’ They went on to note that, ‘Blades are also regularly contaminated with blood, indicating penetration of mucous membranes, which places these items into a high-risk category.’[4] They concluded that the use of single-use blades was ‘to be encouraged’. This infection control would also apply to video laryngoscopes because, regardless of whether direct or indirect, there will always be some form of handle and blade.

1Higgs, A, McGrath, B.A, Goddard, C. Rangasami, J. Suntharalingam, G. Gale, R, Cook, T.M, Guidelines for the management of tracheal intubation in critically ill adults. British Journal of Anaesthesia. 2018; 120 (2): 323-352

2Cook TM and Kelly FE, National Survey of Laryngoscopy in the United Kingdom. British Journal of Anaesthesia. 2017; 118: 593-60

3www.uk.intersurgical.com/info/iview

4Infection Control in Anaesthesia 2. Association of Anaesthetists of Great Britain & Ireland. 2008

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