A demonstration of the Storz C-CAM in endoscopic imagery projection for far forward battlefield telemetric support and training.

Airway management skills are essential for healthcare providers within military and civilian settings. To maintain competency in these skills, it is crucial for the provider to have opportunities for review and retraining. Virtual airway training or telementoring can be an effective means to fulfilling these requirements for healthcare providers located in remote sites. The projection of high quality imagery to far forward locations is essential for health care practitioners in the provision of telemedicine and distance training. The Storz C-CAM was developed to interface with existing endoscopy equipment to facilitate implementation of telemetric devices in remote locations. This work describes the use of the Storz C-CAM in providing medical device training to deployed medical personnel at a far forward location.

Using the intubating laryngeal tube in a manikin - user evaluation of a new airway device.

This work describes the use of a new intubation device, the intubating laryngeal tube (iLTA) as developed by Boedeker. Emergency Department residents and staff from the University of Nebraska Medical Center performed intubations using the Laerdal Difficult Airway Trainer Manikin(TM). The participants' perceived value of the intubating laryngeal tube as well as its efficacy in intubation performance were measured and found to be highly favorable.

Airway management in unusual environments.

Critically injured patients are often found in unusual positions and environments which can hinder the first responder's access to render necessary care. This work describes the use of the videolaryngoscope in airway management of the critically injured patient under unusual conditions.

Endotracheal intubation with a traditional videolaryngoscope blade versus an integrated suction blade in a hemorrhagic airway cadaver model.

Lightly embalmed hemorrhagic cadaver models and the Storz CMAC videolaryngoscope fitted with either an integrated suction blade vs. a traditional blade were used to determine efficacy of the instruments in hemorrhagic airway intubation. Significant differences were found between the devices in intubation success rates of the viscosity saliva and frothy blood models, as well as a significant difference in intubation times in the frothy blood model. Feedback provided by the study participants indicated preference for the integrated video suction blade in hemorrhagic airway intubation.

Virtual simulation training using the Storz C-HUB to support distance airway training for the Spanish Medical Corps and NATO partners.

In medicine, the advancement of new technologies creates challenges to providers both in learning and in maintaining competency in required skills. For those medical providers located in remote environments, access to learning can be even more formidable. This work describes a collaboration created to facilitate the use of new communication technologies in providing distance training and support to health care personnel deployed in remote areas.

User preference comparing a conventional videolaryngoscope blade vs. a novel suction videolaryngoscope blade in simulated hemorrhagic airway intubation.

The hemorrhagic airway makes visualization during laryngoscopy and intubation difficult. A specially designed videolaryngoscope blade with integrated suction was developed and studied in a simulated hemorrhagic airway at the Omaha VA Medical Center. Results show that, if available, many users would choose to include this new suction device in their standard airway carts due to its "always there" design.

Use of a cardiac algorithm in a preoperative evaluation clinic - a pilot study.

The preoperative evaluation is vital in providing information to reduce the risks associated with the anesthesia and surgery and improve the quality of care. In the VA Nebraska-Western Iowa Health Care System, we introduced a computer-based cardiac algorithm as part of the preoperative evaluation software. Following the pre-op examination and use of the algorithm, the provider completed a survey regarding their perceived usefulness of the algorithm software. The survey results showed that effective preoperative evaluation can be performed using a preoperative evaluation clinic, users are receptive to the computer-based format and, in most cases, prefer to have the algorithm software available for use in preoperative assessment.

Telementoring for airway management between a far forward special operations location to a major medical center using inexpensive telemedicine solutions.

Critically ill patients in remote settings have limited access to specialized care. Telemedicine/telementoring can improve access to quality care, although VTC equipment is costly. This study showed that an inexpensive internet telecom software program can be effectively employed in the intubation training of a remote trainee.

Using the Battlefield Telemedicine System (BTS) to train deployed medical personnel in complicated medical tasks - a proof of concept.

This work describes the use of Adobe Connect software along with algorithm software to provide the necessary audio visual communication platform for telementoring a complex medical procedure to novice providers located at a distant site.

Performance comparison of laryngoscopy and suction techniques in a hemorrhagic airway manikin simulator: direct laryngoscopy with Yankauer vs. Storz CMAC with attached suction tip.

Airway management of the hemorrhagic airway can be a difficult skill to master as trainee exposure to this difficult airway may be limited. In this study, we employed a hemorrhagic airway simulator along with a videolaryngoscope and the Storz Boedker-Doerges (BD) suction blade. These devices provided improved intubation performance in this model with respect to traditional direct laryngoscope (DL) and VL blades. This study shows that use of a hemorrhagic simulator could be an effective and valuable training tool in difficult airway intubation training.

Nasotracheal intubation in a difficult airway using the Storz C-MAC Videolaryngoscope, the Boedeker Bougie endotracheal introducer, and the Boedeker curved forceps.

Airway management has multiple indications for nasotracheal intubation. In this study, we focus on its indication in difficult airways. This work describes a modified procedure of nasotracheal intubation using the new Storz CMAC® Videolaryngoscope, the malleable Boedeker Bougie and the curved Boedeker Forceps in the intubation of a difficult airway manikin.

A comparison of an integrated suction blade versus a traditional videolaryngoscope blade in the endotracheal intubation of a hemorrhagic cadaver model - a pilot study.

In this pilot study, we evaluated two types of videolaryngoscope blades (integrated suction vs. traditional) with the Storz CMAC videolaryngoscope in the intubation of a lightly embalmed hemorrhagic cadaver model. No significant differences were found between the devices in the success rates for the intubations. The study subjects indicated a preference for the integrated suction blade in hemorrhagic airway intubation.

Use of a malleable bougie and curved forceps with videolaryngoscopy in airway management training in a cadaver model - a pilot study.

The wider angle of view of videolaryngoscopy versus standard direct laryngoscopy requires an assessment of the adjunctive devices used to facilitate intubation. In this study, subjects performed malleable bougie-assisted intubation and curved forceps removal of a glottic foreign body using videolaryngoscopy on a lightly embalmed cadaver and completed a post-procedure questionnaire. All subjects valued access to the malleable bougie available at their hospitals and 82% valued access to the curved forceps. Malleable bougie and curved forceps seem well-suited to facilitate videolaryngoscopic airway management.

Virtual intubation training at a remote military site.

To provide medical support to the far forward battlefield, training in advanced medical technologies is essential for military healthcare providers. To meet this challenge, the use of modern video communication technologies and novel medical devices can be implemented. This study demonstrates the combined use of modern video conferencing technology and video laryngoscopy equipment in the virtual laryngoscopy training of deployed military medical personnel.

Comparison of the Magill forceps and the Boedeker (curved) intubation forceps for removal of a foreign body in a Manikin.

STUDY OBJECTIVE: To compare the straight Magill and the curved Boedeker Intubation Forceps in foreign body removal in a manikin with a difficult airway using the videolaryngoscope. DESIGN: Prospective comparative study. SETTING: University Medical Center. SUBJECTS: 17 medical providers, 16 anesthesia staff, and one respiratory therapist. MEASUREMENTS: The observed Cormack-Lehane (CL) glottic view and success/failure of the removal attempts were recorded. MAIN RESULTS: The CL scores obtained using the Magill and Boedeker forceps were not significantly different (P = 0.3984). However, the differences in success rates for removal of the foreign object using standard (0 = success, 17 = failure) and Boedeker forceps (0 = failure, 17 = success) were strongly significant (P < 0.0001). CONCLUSION: The curve of the Boedeker Intubation Forceps allows both the tip of the forceps and the glottic opening to be simultaneously visible in the field of view during videolaryngoscopy, making removal of glottic foreign bodies easier.

A comparison of direct versus indirect laryngoscopic visualization during endotracheal intubation of lightly embalmed cadavers utilizing the GlideScope®, Storz Medi Pack Mobile Imaging System™ and the New Storz CMAC™ videolaryngoscope.

BACKGROUND: Studies indicate that the skills needed to use video laryngoscope systems are easily learned by healthcare providers. This study compared several video laryngoscopic (VL) systems and a direct laryngoscope (DL) view when used by medical residents practicing intubation on cadavers. The video devices used included the Storz Medi Pack Mobile Imaging System™, the Storz CMAC® VL System and the GlideScope®. METHODS: After Institutional Review Board (IRB) approval, University of Nebraska Medical Center, Department of Emergency Medicine (UNMC EM) residents were recruited and given a brief pre-study informational period. The cadavers were lightly embalmed. The study subjects were asked to perform intubations on two cadavers using both DL and VL while using the three different VL systems. Procedural data was recorded for each attempt and pre and post experience perceptions were collected. RESULTS: N=14. All subjects reported their varied previous intubation experience. The average airway score using DL: for the Storz VL was 1.54 (SD = 0.576) and for the C-MAC was 1.46 (SD = 0.637). Success in intubation of the standard airway using DL was 93% versus a 100% success rate when intubating with indirect VL visualization. CONCLUSION: Based on our data, we believe that the incorporation of VL into cadaver airway management training provided an improved learning environment for the study residents. In our study, the resident subjects were 93% successful with DL intubation even though 50% had less than 30 intubations. As well, there was a 100% success rate when intubating with indirect VL visualization. In conclusion, the researchers believe this cadaver model incorporated with VL is a powerful tool which may help improve the overall learning curve for orotracheal intubation.

Comparison of a disposable bougie versus a newly designed malleable bougie in the intubation of a difficult manikin airway.

The endotracheal bougie is used for difficult intubations when only a minimal glottic view is obtained. Standard bougies are designed for use during direct, line-of-sight viewing of the glottic opening. With videolaryngoscopy, intubators "see around the corner", thus requiring a bougie which can be shaped to follow a significant curve. A malleable bougie with an imbedded internal wire was created to enable intubators to shape the curve to best fit a difficult airway. This pilot study examined the malleable bougie compared to the SunMed bougie in a simulated difficult airway intubation using video laryngoscopy.

Improving fiberoptic intubation with a novel tongue retraction device.

This study examined the utility of a novel tongue retractor created with a wider working blade and a more ergonomic curve to provide jaw lift and tongue management with one hand during intubation. Anesthesia providers participated in simulated intubation of a difficult manikin using the novel tongue retractor with the Bonfils video fiberscope. Results show that the tongue retractor improved placement success and was well received by the study participants.

Combined intubation training (simulated and human) for 4th year medical students: the Center for Advanced Technology and Telemedicine airway training program.

The video laryngoscope is a useful tool in intubation training as it allows both the trainer and the student to share the same view of the airway during the intubation process. In this study, the Center for Advanced Technology and Telemedicine's airway training program employed videolaryngoscopy (VL) in teaching both simulated (manikin) and human intubation. The videolaryngoscope statistically improved the glottic view in both the standard and difficult manikin airways when compared to that with standard (direct) laryngoscopy. The success rate in simulated difficult airway intubation was significantly improved using VL. With human intubation training, there was statistically significant improvement in airway views using VL and a 97.5% intubation success rate. The enhanced view of the videolaryngoscope in airway intubation facilitates the learning process in performing both simulated and human intubation, making it a powerful tool in intubation training.

Battlefield tracheal intubation training using virtual simulation: a multi center operational assessment of video laryngoscope technology.

Airway management is an essential skill in providing care in trauma situations. The video laryngoscope is a tool which offers improvement in teaching airway management skills and in managing airways of trauma patients on the far forward battlefield. An Operational Assessment (OA) of videolaryngoscope technology for medical training and airway management was conducted by the Center for Advanced Technology and Telemedicine (at the University of Nebraska Medical Center, Omaha, NE) for the US Air Force Modernization Command to validate this technology in the provision of Out of OR airway management and airway management training in military simulation centers. The value for both the training and performance of intubations was highly rated and the majority of respondents indicated interest in having a video laryngoscope in their facility.