An End-user Assessment of the Novel i-view Video Laryngoscope After a Clinical Trial.

Abstract

Introduction: Airway obstruction is a leading cause of potentially survivable death on the battlefield. Intubation remains the most frequently performed prehospital airway intervention. Unfortunately, survival is lower after prehospital intubation compared to the emergency department. After-action review data suggest that forward-staged technology is lacking. Additionally, video laryngoscopy (VL) is superior to direct laryngoscopy, especially in the hands of novice intubators. The i-view is a novel, inexpensive, handheld VL device that showed promise in far-forward areas. However, our clinical study demonstrated inferior clinical performance of the i-view compared to our current standard devices in first-pass success. This study used feedback from intubating operators to identify potential causes of this substandard performance.

Methods: We conducted a prospective survey of intubating operators using the novel video device as part of a clinical trial. We sought their feedback using a Likert scale survey and free text feedback. The study team reviewed the free text feedback using a thematic analysis method.

Results: We surveyed 31 emergency physicians who had used the device (30 fully completed surveys and one partially completed). The lowest-scoring areas were screen brightness, with a median score of 2 (IQR 2-4), and screen resolution, with a median score of 2 (1-4), indicating that these were the major performance challenges. Thematic analysis suggested that the i-view's primary challenges were screen brightness, resolution, visibility through bodily fluids, and fogging.

Conclusions: Our survey highlighted multiple issues with i-view's use. Our findings will inform device development and modification for prehospital deployed use.