An Innovative Approach to Airway Securement in Civilian and Military Emergency Trauma
Current practices for airway management in traumatic injury care are profoundly inadequate. During immediate care of a trauma patient, securing the airway is often the top priority for the attending provider. Studies have shown that tracheal intubation complications occurred in ~20% of attempts. Surgical airways such as cricothyrotomy are often promoted as an alternative, but pre-hospital failure rates ranging from 18-33% suggest this approach is not a viable solution.
Discussions with experienced medics and emergency health professionals have identified possible shortcomings, outside of training and experience limitations, in the standard-of-care approach to endotracheal intubation: 1) Failure to locate the trachea because of injury, swelling, presence of debris, etc.; 2) Inability to insert the ET tube properly because of environmental conditions and trauma, and because the tube is a large, fixed-diameter, inflexible device that does not adapt well to anatomical variations; and 3) Improper securement resulting in unintended dislodgement, leading to airway failure.To address these needs, we propose a complete re-engineering of the endotracheal (ET) tube through innovative geometrical designs, incorporation of smart materials, and integration of real-time feedback systems. To do this, we will assess the viability of utilizing: 1) shape memory materials (SMMs); 2) phase transforming cellular materials (PXCMs); and 3) feedback sensors (e.g. spectral reflectance) to produce an innovative ET tube design with substantially enhanced performance and ease of use. Research objectives include designing and fabricating the novel ET tube designs based on SMMs and PXCMs, integrating feedback sensors, and testing the completed prototypes in cadaver and mannequin models.