The big new trend at EMS Today this year was the rapid growth of new optical and video intubation devices. It’s particularly incongruous that in a month when the big feature article in JEMS is about “The Vanishing ET Tube”, our industry introduces several new tools that make intubation easier and possibly safer.
Larger versions of these devices have been in most anesthesiologists’ arsenal for years. They allow the clinician to view the intubation procedure on a remote
screen. A few of these devices can provide a better view of the glottis in high definition color. Manufacturers continue to make them smaller and more rugged with some models engineered specifically for EMS use. I saw several brand-new intubation devices at EMS Today. Some I had never even heard of previously. Every single one was of very high-quality construction. Many hold the promise to make quickly securing a definitive advanced airway easier, safer, and faster.
The first two that caught my attention came from Clarus Medical. One features a compact screen on the handle. It blends the benefits of an optical stylet with video technology. It can display or export the video signal with a convenient USB port. The second was the new Levitan FPS Scope. This device is a malleable fiber optical stylet with a small view port and oxygen insufflation port. This provides assistance to those learning how to use the device by exploiting that little-credited teacher’s helper, body memory.
Body memory is what allows you to ride a bicycle even if you have not done so for decades — your body remembers how, but it needs plenty of repetition to
acquire the memory. Developing that body memory is what becomes mission-critical with each new trick in your bag. How many tricks will you try to learn to do well and what other skill could that effort degrade. These are the issues that can complicate and reduce the net value of acquiring new skills.
That’s what I like about the Levitan Scope: it’s the same old laryngoscopy technique I’ve always used before, just with an added twist at the end. You hold the Levitan in your right hand with your ET tube loaded on it, and a laryngoscope in your left hand just like you are used to. Once you see the tip approach the glottis, you transition from looking in the mouth to looking through the eye port to pass the tube under direct visualization. You can follow the tube all the way in and watch as it passes through the chords. If for any reason the view becomes obscured, as what might occur with blood or vomitus in the airway, you still have a great fallback position.
Next you turn on the special LED at the stylets tip and use it just like a light wand for trans-illuminated tracheal intubation. Frankly I could see just using it as a stylet on easy tubes. After all, as you approach the glottis, if youcan see it easily enough, you’ll probably stick it in. Personally, I’d like to play with the idea of turning on the trans-illuminating LED light as I begin to insert the tube – for routine external visual confirmation of placement as I pass the glottis. I see the potential for this one device, the Levitan, to provide an escalating level of response to each individual airway challenge. It’s also one of the most compact and economical of the new intubation devices I saw at the show
A sexy new video laryngoscope on display was the C-MAC Video Laryngoscope from Karl Storz. This versatile system operates in a similar manner to the Ranger Glidescope. It has a laryngoscope component and a separate view screen system. The quality was simply stunning, with the robust laryngoscope component exhibiting the finish and feel of an expensive handgun. This stuff is so nice I was a little nervous to ask how much it cost. But for best in class, these systems have to be on your short list.
The public did not get a chance to see the new Coopdech C-Scope, but we received a private showing. This video laryngoscope has a traditional look, with a screen that while not as vividly clear as the Pentax, was noticeably larger and located right on the handle. The handle itself provides a more traditional laryngoscope feel, and uses replaceable blades that will come in a variety of sizes and style.
The next new advancement in intubation looked like a regular laryngoscope with two lights. But it is far more than it initially appears. The IntuBrite has a second Ultraviolet light, which causes the vocal chords to stand out like you have never seen them before. The blades themselves are completely disposable. The handle is also very innovative — it has a much more ergonomic design which enhances operator control. The curved shape helps you direct the lifting force to its greatest advantage.
We can always strive to do a better job of managing the emergency airway. New technologies such as those we saw at EMS Today may prove to have a vital role. Some of these new devices are not really expensive when compared to the cost of a new LED light bar; the price justifies itself considering the potential benefit. We can – and should — be masters of a full range of critical life-saving skills that reflect the best standards of care and advancements in technology. As a matter of fact, that’s what we have always done.