Abstract
Purpose
Due to failures that occur during intubation, some authors advocate that intubation should always be done with a video laryngoscope. What makes the implementation of this recommendation difficult, especially in developing countries, is the high price of the device. Thus, the objective of this study is to present a low-cost video laryngoscope developed via additive manufacturing, being the first device to have the safety parameters duly tested according to the ISO 7673:2020 standard.
Methods
A video laryngoscope with a Macintosh-type rigid blade was developed. After modeling it in the CAD-3D SolidWorks® program, the prototype was printed in PLA (polylactic acid), and load and fatigue tests were carried out with the MTS 810/793 testing machine.
Results
The main results were an improvement in ergonomics (with a better fixation of the camera wire and camera positioning). Load and fatigue tests showed compliance with the requirements of the ISO 7673:2020 standard. The first is that when subjected to a traction force of 65 N, the center of illumination must not move more than 10 mm (the average movement was only 3.95 mm). The second is that when subjected to a traction force of 150 N, the laryngoscope blade must not break (348 N of load was applied and the piece resisted without breaking).
Conclusion
It was shown that the Macintosh-type PLA video laryngoscope has the potential to become a safe and low-cost tool in the emergency intubation arsenal.
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References
Amaro S, Máximo M, Rodeia SC, Freitas P. Via Aérea Difícil Em Emergência Pré-Hospitalar: Realidade Portuguesa. Revista Da Sociedade Portuguesa de Anestesiologia. 2019;28(3):167–73. https://doi.org/10.25751/rspa.18115.
Apfelbaum JL, Hagberg Carin A, Connis Richard T, Abdelmalak Basem B, Agarkar Madhulika, Dutton Richard P, Fiadjoe John E, et al. 2022 American Society of Anesthesiologists practice guidelines for management of the difficult airway. Anesthesiology. 2021. https://doi.org/10.1097/ALN.0000000000004002.
Apfelbaum Jeffrey L, Hagberg Carin A, Connis Richard T, Abdelmalak Basem B, Agarkar Madhulika, Dutton Richard P, Fiadjoe John E, et al. 2022 American Society of Anesthesiologists practice guidelines for management of the difficult airway. Anesthesiology. 2022;136(1):31–81. https://doi.org/10.1097/ALN.0000000000004002.
Brewster DJ, Chrimes N, Do TBT, Fraser K, Groombridge CJ, Higgs A, Humar MJ, et al. Consensus statement: safe airway society principles of airway management and tracheal intubation specific to the COVID-19 adult patient group. Med J Australia. 2020;212(10):472–81. https://doi.org/10.5694/mja2.50598.
Cabrera D, Massano G, Fernández S, Chaile S, Alday A, Patiño C, Ravetta P, Defagó V. Low cost laryngoscope video developed using 3D printing technology. Revista Chilena de Anestesia. 2018;47(4):259–62. https://doi.org/10.25237/revchilanestv47n04.08.
Carney N, Totten AM, Cheney T, Jungbauer Ra, Neth Matthew R, Weeks Chandler, Davis-O’Reilly, C, et al. Prehospital airway management: a systematic review. Prehospital Emergency Care. 2021;26(5):716–27. https://doi.org/10.1080/10903127.2021.1940400.
Cook TM. Strategies for the prevention of airway complications – a narrative review. Anaesthesia. 2018;73(1):93–111. https://doi.org/10.1111/anae.14123.
Cook TM, Boniface NJ, Seller C, Hughes J, Damen C, Macdonald L, Kelly FE. Universal videolaryngoscopy : a structured approach to conversion to videolaryngoscopy for all intubations in an anaesthetic and intensive care department. British J Anaesthesia. 2018;120(1):173–80. https://doi.org/10.1016/j.bja.2017.11.014.
Cook TM, El-Boghdadly K, McGuire B, McNarry AF, Patel A, Higgs A. Consensus guidelines for managing the airway in patients with COVID-19: guidelines from the Difficult Airway Society, the Association of Anaesthetists the Intensive Care Society, the Faculty of Intensive Care Medicine and the Royal College of Anaesthetist. Anaesthesia. 2020;75(6):785–99. https://doi.org/10.1111/anae.15054.
Cox L, Tebbett A. Videolaryngoscopy versus direct laryngoscopy for endotracheal intubation of cardiac arrest patients in hospital: a systematic literature review. Resuscitation Plus. 2022;11(August):100297. https://doi.org/10.1016/j.resplu.2022.100297.
de Almeida VS. (2021) Desafios Da Prototipagem, Confecçao e Utilizaçaão de Videolaringoscópios Produzidos Em Manufatura Própria Em Impressoras 3d. Brazilian Journal of Anesthesiology, 309–11.
De Jong A, Sfara T, Pouzeratte Y, Pensier J, Rolle A, Chanques G, Jaber S. Videolaryngoscopy as a first-intention technique for tracheal intubation in unselected surgical patients: a before and after observational study. British J Anaesthesia. 2022;129(4):624–34. https://doi.org/10.1016/j.bja.2022.05.030.
Dey, Arup, and Nita Yodo. 2019. A systematic survey of FDM process parameter optimization and their influence on part characteristics. J Manufact Materials Proc. 3(3). https://doi.org/10.3390/jmmp3030064.
Downey AW, Duggan LV, Adam Law J. A systematic review of meta-analyses comparing direct laryngoscopy with videolaryngoscopy. Canadian J Anesthesia. 2021;68(5):706–14. https://doi.org/10.1007/s12630-021-01921-7.
Findik M, Kayipmaz AE, Kavalci C, Sencelikel T, Muratoglu M, Akcebe A, Gungorer B, Kavalci G. Why USB-endoscope laryngoscopy is as effective as video laryngoscopy. Clin Investigative Med. 2020;43(2):E55-59. https://doi.org/10.25011/cim.v43i2.33956.
Guerra-Hernández M, Vidaña-Martínez GJ, Camacho-Juárez JS, Barragán-Villegas H, Calacuayo-Rojas JE, Reyes BA, Castañón-González JA, Núñez-Olvera OF, Del PilarFonseca-Leal Ma. Novel video-laryngoscope with wireless image transmission via Wi-Fi towards a smartphone. Electronics (Switzerland). 2020;9(10):1–12. https://doi.org/10.3390/electronics9101629.
Hall D, Steel A, Heij R, Eley A, Young P. Videolaryngoscopy increases ‘mouth-to-mouth’ distance compared with direct laryngoscopy. Anaesthesia. 2020;75(6):822–3. https://doi.org/10.1111/anae.15047.
Hansel J, Rogers AM, Lewis SR, Cook TM, Smith AF. Videolaryngoscopy versus direct laryngoscopy for adults undergoing tracheal intubation: a Cochrane systematic review and meta-analysis update. British J Anaesthesia. 2022;129(4):612–23. https://doi.org/10.1016/j.bja.2022.05.027.
Higgs A, McGrath BA, Goddard C, Rangasami J, Suntharalingam G, Gale R, Cook TM. Guidelines for the management of tracheal intubation in critically ill adults. British J Anaesthesia. 2018;120(2):323–52. https://doi.org/10.1016/j.bja.2017.10.021.
Huysamen, et al. 3D printed laryngoscope for endotracheal intubation H.W. S Afr J Ind Eng. 2020;31(November):209–17.
ISO 7376:2020 International standard ISO Anaesthetic and respiratory equipment — laryngoscopes for tracheal intubation
Karippacheril JG, Umesh G, Ramkumar V. Inexpensive video-laryngoscopy guided intubation using a personal computer: initial experience of a novel technique. J Clin Monitor Comput. 2014;28(3):261–4. https://doi.org/10.1007/s10877-013-9522-x.
Kristiawan RB, Imaduddin F, Ariawan D, Ubaidillah, Arifin Z. A review on the fused deposition modeling (FDM) 3D printing: filament processing, materials, and printing parameters. Open Eng. 2021;11(1):639–49. https://doi.org/10.1515/eng-2021-0063.
Lambert CT, John SC, John AV. Development and performance testing of the low-cost, 3D-printed, smartphone-compatible ‘Tansen videolaryngoscope’ vs Pentax-AWS videolaryngoscope vs direct Macintosh laryngoscope a Manikin study. Eur J Anaesthesiology. 2020;37(11):992–8. https://doi.org/10.1097/EJA.0000000000001264.
Lanzotti A, Grasso M, Staiano G, Martorelli M. The impact of process parameters on mechanical properties of parts fabricated in PLA with an open-source 3-D printer. Rapid Prototyp J. 2015;21(5):604–17. https://doi.org/10.1108/RPJ-09-2014-0135.
Longhitano GA, Nunes GB, Candido G, da Lopes Silva JV. The role of 3D printing during COVID-19 pandemic: a review. Prog Additive Manufacturing. 2021;6(1):19–37. https://doi.org/10.1007/s40964-020-00159-x.
Maconochie IK, Aickin R, Hazinski MF, Atkins DL, Bingham R, Couto TB, Guerguerian AM, et al. Pediatric Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation. 2020;156:A120-55. https://doi.org/10.1016/j.resuscitation.2020.09.013.
Malhotra SK. Practice guidelines for management of the difficult airway. Pract Guide Anesthesia. 2016;2:127–127. https://doi.org/10.5005/jp/books/12644_18.
Marcillo M, Mauricio C, MeléndezOrdoñez JA, Montes Ríos AR. Hybrid laryngoscope a reasonable option cost for approaching the airway difficulty a case report. Revista Chilena de Anestesia. 2021;50(5):712–5. https://doi.org/10.25237/revchilanestv5011081459.
Matehuala-Morán I, Pérez AYP, Fuentes-Alvarez R, Fernández JAB, Hernandez-Gilsoul T, Villaseñor PAS, Rojas-Vega L, de Jesús M, Cadena R, Alfaro-Ponce M. Design and additive construction of a video-laryngoscope for endotracheal intubation of adult patients. Front Mater. 2022;9(May):1–14. https://doi.org/10.3389/fmats.2022.906851.
Milano B, Elaine J, Monsalve P, Escalona G. Mobile laparoscopy: use of the smartphone as a tool in the operating room. Gastroenterol Hepatology: Open Access. 2019;10(5):272–7. https://doi.org/10.15406/ghoa.2019.10.00395.
Mushambi MC, Kinsella SM, Popat M, Swales H, Ramaswamy KK, Winton AL, Quinn AC. Obstetric Anaesthetists’ Association and Difficult Airway Society Guidelines for the management of difficult and failed tracheal intubation in obstetrics. Anaesthesia. 2015;70(11):1286–306. https://doi.org/10.1111/anae.13260.
Pandit JJ, Popat MT, Cook TM, Wilkes AR, Groom P, Cooke H, Kapila A, O’Sullivan E. The Difficult Airway Society ‘ADEPT’ guidance on selecting airway devices: the basis of a strategy for equipment evaluation. Anaesthesia. 2011;66(8):726–37. https://doi.org/10.1111/j.1365-2044.2011.06787.x.
Piepho T, Cavus E, Noppens R, Byhahn C, Dörges V, Zwissler B, Timmermann A. S1-Leitlinie Atemwegsmanagement: Leitlinie Der Deutschen Gesellschaft Für Anästhesiologie Und Intensivmedizin (DGAI). Anaesthesist. 2015;64(January):27–40. https://doi.org/10.1007/s00101-015-0109-4.
Pinheiro SS, Pereira WA. Recomendações Para Ressuscitação Cardiopulmonar de Pacientes Pediátricos Com Diagnóstico Ou Suspeita de COVID-19. Amib. 2020. https://www.amib.org.br/fileadmin/user_upload/amib/2020/maio/19/AMIB_Recomendacoes_Pediatria_Depto_Enferma
Sabry A, Mohammad HI, Aboughazy AM. The use of USB endoscope (borescope) to guide nasal tracheal intubation: a pilot study. Res Opinion Anesthesia Intensive Care. 2020;7(1):65. https://doi.org/10.4103/roaic.roaic_86_18.
Salis-Soglio Nicolaus V, Hummler Helmut, Schwarz Stephan, Mendler Marc R. Success rate and duration of orotracheal intubation of premature infants by healthcare providers with different levels of experience using a video laryngoscope as compared to direct laryngoscopy in a simulation-based setting. Frontiers in Pediatrics. 2022;10(November):1–9. https://doi.org/10.3389/fped.2022.1031847.
Santana L, Alves JL, Sabino Netto AD, Merlini C. A comparative study between PETG and PLA for 3D printing through thermal, chemical and mechanical characterization. Revista Materia. 2018;23(4). https://doi.org/10.1590/s1517-707620180004.0601.
Xue FS, Li HX, Liu YY, Yang GZ. Current evidence for the use of C-MAC videolaryngoscope in adult airway management: a review of the literature. Therapeut Clin Risk Manage. 2017;13:831–41. https://doi.org/10.2147/TCRM.S136221.
Uribe, Valentina Franco, Duván Andrés, Vélez Ríos, Laura Chavarriaga Jiménez, Juan Diego, Andrés Felipe, Prado Reina, Juan Camilo, Gómez Salgado, and Mauricio Calderón. 2019. Borescope Vs laryngoscope in difficult airway management by non-expert personnel : a non- randomized pilot study in a simulated environment. JSM Clin Anesthesiol, 1–5.
Vargas M, Servillo G, Buonanno P, Iacovazzo C, Marra A, Putensen-Himmer G, Ehrentraut S, et al. Video vs. direct laryngoscopy for adult surgical and intensive care unit patients requiring tracheal intubation: a systematic review and meta-analysis of randomized controlled trials. Eur Rev Med Pharmacolog Sci. 2021;25(24):7734–49. https://doi.org/10.26355/eurrev_202112_27620.
Verma I, Verma C, Dhaked S, Sharma R. A randomised comparative interventional prospective study of intubation by Macintosh laryngoscope versus McGrath video laryngoscope in patients undergoing cardiac surgery. Anesthesia Crit Care. 2020;02(02):52–65. https://doi.org/10.26502/acc.015.
Acknowledgements
This study was financed in part by CNPq with a productivity scholarship in technological development and innovative extension (DT2).
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Alves, M.A., Foggiatto, J.A., Berti, L.F. et al. The development of video laryngoscope via additive manufacturing for use in a pre-hospital environment. Res. Biomed. Eng. 40, 15–23 (2024). https://doi.org/10.1007/s42600-023-00326-3
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DOI: https://doi.org/10.1007/s42600-023-00326-3