Maintaining an open airway is a critical priority in emergency medicine. Without the flow of oxygen, other emergency interventions can become ineffective at saving the patient’s life. However, creating this airway through endotracheal intubation is a difficult task for highly trained individuals and under the best of circumstances. In the field and in the ER, where seconds matter, emergency medical personnel face many unknowns and wildly challenging conditions which lower their chances of success.
But what if successful endotracheal intubation could be less reliant on ideal conditions and years of specialized training? In a paper published in the journal Science Translational Medicine, UC Santa Barbara researchers David Haggerty, Elliot Hawkes and collaborators demonstrate a non-electronic soft robotic device that quickly and autonomously guides a soft tube into the trachea. Initial device testing with highly trained users yielded a 100% success rate, and a 96% overall success rate with prehospital medical providers (EMTs and paramedics).
“Current intubation tools require extensive anatomical knowledge, training, skill and ideal conditions to be highly successful,” said recent UC Santa Barbara Ph.D. graduate David Haggerty, a former researcher in the lab of mechanical engineering professor Elliot Hawkes. Current technology calls for the rescuer to first visualize the tracheal opening then manually direct a tube through the serpentine anatomy of the airway into the trachea. The challenge of this procedure increases in prehospital settings due to various factors including inadequate light and nonideal body position in addition to potential injuries and fluid in the airway.
This project is supported in part with funds from the National Science Foundation
From rigid tools to soft robotics
One of the main challenges to successful intubation is the body itself, and the mechanisms it has evolved to prevent food and foreign bodies from entering the lungs. The epiglottis is a small fleshy flap that closes over the trachea and guides food and liquid into the adjacent esophagus with each swallow. Conventional practice typically requires the rescuer to push a metal laryngoscope into the back of the mouth behind the tongue to lift the epiglottis out of the way in order to make room for the breathing tube.
But even with the epiglottis out of the way, the path the endotracheal tube must take is a twisted one, as it has to bend toward the front of the neck where the trachea is located, otherwise air could be delivered to the stomach via the esophagus, instead of to the lungs.
“Traditional tools, which you push from the base, are fundamentally limited in navigating delicate, tortuous anatomy,” Hawkes explained. “They must be relatively stiff so you can push them, and can only get around bends by deflecting off the sensitive tissue.”