A soft robotic device for rapid and self-guided intubation

Abstract

Endotracheal intubation is a critical medical procedure for protecting a patient's airway. Current intubation technology requires extensive anatomical knowledge, training, technical skill, and a clear view of the glottic opening. However, all of these may be limited during emergency care for trauma and cardiac arrest outside the hospital, where first-pass failure is nearly 35%. To address this challenge, we designed a soft robotic device to autonomously guide a breathing tube into the trachea with the goal of allowing rapid, repeatable, and safe intubation without the need for extensive training, skill, anatomical knowledge, or a glottic view. During initial device testing with highly trained users in a mannequin and a cadaver, we found a 100% success rate and an average intubation duration of under 8 s. We then conducted a preliminary study comparing the device with video laryngoscopy, in which prehospital medical providers with 5 min of device training intubated cadavers. When using the device, users achieved an 87% first-pass success rate and a 96% overall success rate, requiring an average of 1.1 attempts and 21 s for successful intubation, significantly (P = 0.008) faster than with video laryngoscopy. When using video laryngoscopy, the users achieved a 63% first-pass success rate and a 92% overall success rate, requiring an average of 1.6 attempts and 44 s for successful intubation. This preliminary study offers directions for future clinical studies, the next step in testing a device that could address the critical needs of emergency airway management and help democratize intubation.