# New Intubation Method - looking for feedback from the field



## Ishay Benuri MD (Mar 19, 2017)

Hi all. My name is Ishay Benuri. I am a pediatric gastroenterologist who volunteers in as an EMT at United Hatzalah service in Israel.

After I failed to intubate a trauma patient in the field, I developed a device that is mainly intended as a bridged till a novice paramedic reaches high level of proficiency in endotracheal intubation.

The device is also intended for video assisted laryngoscopy (since even with proper visualization of the vocal cords, guiding the tube in is not always simple). I'll be grateful for any feedback regarding the technology.


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## OnceAnEMT (Mar 19, 2017)

Welcome. Interesting approach. I'm not at that level yet, but I do have some questions. 

Are you constructing these as a modification to a stock laryngoscopes, or are they a whole new device?

What material is the loop made of?


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## Ishay Benuri MD (Mar 19, 2017)

Good question, Grimes. Both approaches are possible. The company that will agree to manufacture the device will have to decide what it prefers (mainly financial decision). The loop will be made of plastic tubing that can be detached on one side of the blade by a press of a button after the insertion has been accomplished, The practitioner doesn't have to use the loop,  he can introduce the device when difficult intubation is  anticipated and use the added feature only if he needs too..


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## Akulahawk (Mar 19, 2017)

Interesting concept. From what I saw of the video, it appears that this device basically just something to pull on the intubation device (bougie or ETT) and aim it more squarely at the glottis and therefore introduce it into the trachea. Is this device designed to work with a bougie so that you can then slide an ETT over bougie like would normally be done with a bougie-assisted intubation or is it also designed to be used with standard endotracheal tubes so a bougie doesn't necessarily have to be used? 

In a sense, this seems to be to be a device that takes the place of digital intubation. Fortunately I've never had to use that technique and if I do, I hope to never get bit...


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## EpiEMS (Mar 19, 2017)

Stepping a titch further back, I'm curious why advanced airway management was being performed at what I presume was an MCI?


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## E tank (Mar 19, 2017)

Couple of thoughts...If the glottis is so difficult to target in these situations, how is this loop going to be any easier? Even if the operator does hit the loop, the tube/bougie has to be at the precise level of the glottis in order to be drawn anteriorly without being impeded or obstructed by the tissue between the UES and the glottis.  That will be very difficult to do in emergency intubations. 

By the looks of the procedure in the video, in order to be consistently successful using the technique, you'd need to be an expert laryngoscopist . This introduces another order of complexity rather than taking one away.

My opinion.


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## Ishay Benuri MD (Mar 19, 2017)

Thank you  Akulahauk for bring this up. The device is intended for both bougie and ETT, but at the initial  prototype  phase it was simpler to target the bougie as the tube of choice. 
I believe  that digital intubation is here  to stay and that in the near future blind intubation will  be unacceptable (though it could be easily  accomplished with this device). Still 1st pass failure rate in VL is 8-30% and the better we see with VL doesn't mean we clear the path to the tube -the opposite  is true we try less to do so. Thus, I believe that his tube maneuvering device will be more and more essential  as video assisted intubation becomes more common .

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## Handsome Robb (Mar 19, 2017)

EpiEMS said:


> Stepping a titch further back, I'm curious why advanced airway management was being performed at what I presume was an MCI?



Where'd you get MCI from his post? Just because it's a trauma patient in Israel? 


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## Ishay Benuri MD (Mar 19, 2017)

That's  also an important point E tank. I must point out that my main goal  was not to complicated an already  complicated  situation; that's  why I insisted  that the device  won't  change anything  from what the EMT is used to. He/she slides in the  device without needing to take into account  the loop and does the procedure as he used to. If the blade is not at all at the right  place (let's say at the teeth  level in the esophagus) the device won't  be helpful.  But if he is close  to the glottis the loop doesn't  only approximates the tube but also creates  a "step" that the intubator can use to curve the tip anteriorly.

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## EpiEMS (Mar 19, 2017)

Handsome Robb said:


> Where'd you get MCI from his post? Just because it's a trauma patient in Israel?



Totally outside knowledge - knew folks who were there at the time of this particular car attack incident, and it was a ~13 patient incident.


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## Ishay Benuri MD (Mar 19, 2017)

It was MCI. But I couldn't  know that because most of the casualties  were about a 100 meter away. I had a one severely injured casualty in my vicinity.

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## MonkeyArrow (Mar 19, 2017)

Handsome Robb said:


> Where'd you get MCI from his post?


If you watched the video, the subtitle said, "He tries to intubate the most severely injured casualty while stabilizing his neck." Based on this statement, an appropriate inference could be made that there are multiple patients and that triage had been conducted, both of which lead to a logical conclusion of an MCI.


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## Handsome Robb (Mar 19, 2017)

MonkeyArrow said:


> If you watched the video, the subtitle said, "He tries to intubate the most severely injured casualty while stabilizing his neck." Based on this statement, an appropriate inference could be made that there are multiple patients and that triage had been conducted, both of which lead to a logical conclusion of an MCI.



Ah fair enough. I didn't watch it. 


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## MonkeyArrow (Mar 19, 2017)

My question is how is this device operationally different than a (specialty) laryngoscope blade with a flex-tip to help lift anterior anatomy and help provide a cleaner path to the cords?


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## hometownmedic5 (Mar 19, 2017)

I can see people monkeying around trying to put the bougie through the loop when that time could be spent monkeying around trying to put the tube through the cords.

Basically, instead of dumbing down ETI with gadgets, I'm more in favor of smartening up with longer and recurring airway management training for paramedics; along with minimum competency evaluations often enough to maintain proficiency. I have to take a 12ld competency test every year, even though i read them and  treat accordingly daily; but nobody has seriously evaluated my intubation skills since my registry practical(if you're even willing to consider that a worthwhile evaluation(which I'm not)).

As usual, I'm going to take the position of higher education as the answer, not toys or lower expectations. None of the above is to say that the device in questions isn't innovative and intriguing. It's a good bit of brain work there Dr, i just dont personally feel as if it is the correct solution to the problem you have identified.


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## E tank (Mar 19, 2017)

Ishay Benuri MD said:


> If the blade is not at all at the right  place (let's say at the teeth  level in the esophagus) the device won't  be helpful.  But if he is close  to the glottis the loop doesn't  only approximates the tube but also creates  a "step" that the intubator can use to curve the tip anteriorly.
> 
> Sent from my SM-G800F using Tapatalk



Well, that's just it, Dr. Benuri, the leading edge of the blade (that is, the tip) needs to be engaging the epiglottis in one way or the other (in the valecula or lifting it) in order to have the loop in position to be able to align the bougie with the glottic axis. It seems to me, you'd be putting the bougie/tube right thru the glottis to snare the loop, in which case you'd be where you'd want to be without engaging the loop.


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## E tank (Mar 19, 2017)

MonkeyArrow said:


> My question is how is this device operationally different than a (specialty) laryngoscope blade with a flex-tip to help lift anterior anatomy and help provide a cleaner path to the cords?



Those blades manipulate the anatomy, while his manipulates the tube. There is a reason why those blades didn't catch on.


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## Carlos Danger (Mar 19, 2017)

I think it's an interesting concept, considering that difficulty in entering the glottis with the ETT seems to be a somewhat common problem, even when a good view is obtained.

I don't know how useful it would be in actual practice. I think a lot would come down to the design of the actual device, and how easy it is to use.


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## FLMedic311 (Mar 19, 2017)

I feel like @E tank said it best in that this device is self limiting in that only someone that is well trained and experienced in proper positioning, anatomy, and epiglottoscopy.


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## Ishay Benuri MD (Mar 20, 2017)

First of all, I would like to express my sincere appreciation to this forum (the 1st forum I presented my device to)! All the issues raised above are very important to address and it helps me understand what I need to clarify in my future presentations. I'll try to address all the points you guys raised. I'll do it in several posts (between meetings and patients…).


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## DesertMedic66 (Mar 20, 2017)

I'd imagine the lever would be in a pretty awkward position while intubating. For me I would not be able to squeeze the lever due to my thumb/palm being on the main handle.


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## Ishay Benuri MD (Mar 20, 2017)

MonkeyArrow said:


> My question is how is this device operationally different than a (specialty) laryngoscope blade with a flex-tip to help lift anterior anatomy and help provide a cleaner path to the cords?



My device is not intended to change the position of the anatomy rather it is a device that uses the anatomy (thus is much more safe and effective). One of the drawback of the flex-tip (as far as I understood from a paramedic that used it) was that besides only minimally changing the view, the need to remove the thumb to press the trigger during maximal force was very difficult. In my device you don't need to use substantial force to change the anatomy, you only need to place the laryngoscope in the right position and constricting the loop  does all the work. I believe (I might be wrong..) that if the novice EMT will concentrate and trained to just find the vallecula and less to try and see the cords (which my device enables), it will improve the learning curve substantially .


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## Ishay Benuri MD (Mar 20, 2017)

DesertMedic66 said:


> I'd imagine the lever would be in a pretty awkward position while intubating. For me I would not be able to squeeze the lever due to my thumb/palm being on the main handle.


You are so right, Desert Medic66! If I had to both induce force on the handle and press the handle together, it would be very awkward for me also. But if you only need to use minimal strength on the handle, pressing the trigger becomes very comfortable. I should mention that I also patented a special trigger handle that is requires minimal pressing to achieve desired loop constriction, so even medics with small hands could use it.


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## Ishay Benuri MD (Mar 20, 2017)

hometownmedic5 said:


> I can see people monkeying around trying to put the bougie through the loop when that time could be spent monkeying around trying to put the tube through the cords.








Thank you hometownmedic5 for bringing this up. This is an image of the prototype (used an endoscopic snare as a loop - will be made of plastic tubing in future models). As you can see - even if you try hard you couldn't enter a bougie or tube not through the loop. Also as I mentioned before you don't have to use this feature at all. If you are able to insert the tube through the cords, you don't need to do any additional steps besides pressing a button that disconnects one side of the loop and withdraw the laryngoscope.


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## Ishay Benuri MD (Mar 20, 2017)

By the way, I held the position you see in the above image (CL3) for volunteers who never held a laryngoscope in their life. They all succeded 1st attempt intubation (with out seeing any vocal cords).


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## medicsb (Mar 20, 2017)

Not quite sold on the device, but the idea of something helping to guide the bougie or ETT anteriorly is not a bad idea.  Part of learning to manage a difficult airway is know where to aim the tube when you can see the epiglottis but not the cords, which means aiming the tube or bougie anteriorly.  I had a difficult airway the other day for which the CMAC didn't help (I used the disposable blade version, which I now think is far inferior to the non disposable version).   After goosing the tube, I changed to DL and a bougie and aimed anterior with success.  Usually I have success with just aiming the ETT anterior, but I have on occasion have had that not work due to what I suspect is too acute of an angle for me to pass the tube, and this sort of device intends to help navigate that angle.  

Unless well-experienced with intubation, I would generally advise against aiming anterior, but something like this might make me more comfortable with novices doing such.


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## VFlutter (Mar 20, 2017)

I like the concept however I do not necessarily see a benefit over using a bougie and the "trigger" method. I do not tend to have trouble manipulating the bougie anteriorly.


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## E tank (Mar 20, 2017)

The first image is a stylet that, when advanced, anteriorly directs the tube to the degree that the operator needs.  The second has a pull ring that shortens the inside curve of the tube and thus directs the tip of the tube anteriorly to the degree that the operator needs.


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## Ishay Benuri MD (Mar 21, 2017)

Thank you E tank, this is an issue that I really need this forum to help me with - I am posting again the image of my prototype demonstrating Cormack 3 position - I would be grateful for your feedback and feedback from others - what would you prefer in this situation (emergency scenario)? A tube with maneuvering capabilities or the loop mechanism I proposed. Also what do you believe would be more efficient for a novice EMT (also in emergency scenarios)?


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## NomadicMedic (Mar 21, 2017)

Eliminate all the issues with an SGA.


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## Ishay Benuri MD (Mar 21, 2017)

NomadicMedic said:


> Eliminate all the issues with an SGA.


Thank you NomadicMedic. I recieved this reply from about 10% of the paramedics I contacted. They especially mentioned the King LT-D. I couldn't figure out why didn't the rest of the paramedics offer this solution as the ultimate device. Does it have any drawbacks?


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## NomadicMedic (Mar 21, 2017)

Ishay Benuri MD said:


> Thank you NomadicMedic. I recieved this reply from about 10% of the paramedics I contacted. They especially mentioned the King LT-D. I couldn't figure out why didn't the rest of the paramedics offer this solution as the ultimate device. Does it have any drawbacks?



In the case of an MCI, if you were attempting an airway at all, I'd vote SGA. Especially if it presents as a difficult airway on the first look. The King is an easy to place blind insertion device and would serve to mange that airway until the patient was evacuated to the hospital.

While I applaud your inventiveness, this seems like another tool created to solve a problem that doesn't really exist. If a medic can't intubate on the first pass unassisted, they shoukd be trained to move to a bougie or VL or (my preference) elect to place an SGA.


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## Ishay Benuri MD (Mar 21, 2017)

NomadicMedic said:


> While I applaud your inventiveness, this seems like another tool created to solve a problem that doesn't really exist


Thanks again NomadicMedic, I appreciate the complement. I have to understand a crucial point you brought up "a problem that doesn't really exist". What do you mean by that?


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## Ishay Benuri MD (Mar 21, 2017)




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## Ishay Benuri MD (Mar 21, 2017)




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## Ishay Benuri MD (Mar 21, 2017)

NomadicMedic said:


> Eliminate all the issues with an SGA.



SGA certainly has its problems and hasn't replaced endotracheal intubation in the OR (and that's in ideal setting for SGA - fasting patient, not requiring chest compression) - bellow a survey published 2010 (more than 2 decades after LMA has been introduced).


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## Ishay Benuri MD (Mar 21, 2017)

NomadicMedic said:


> If a medic can't intubate on the first pass unassisted, they shoukd be trained to move to a bougie or VL or (my preference) elect to place an SGA.


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## Ishay Benuri MD (Mar 21, 2017)

NomadicMedic said:


> this seems like another tool created to solve a problem that doesn't really exist


Isn't there something weird in the following data: CL grade I view 83%, 1st pass success only  73.3% (20% of the cases it took more than 2 minutes).


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## StCEMT (Mar 21, 2017)

I'll throw in my $0.02 as the newbie that you are directing this product to. I understand your idea and like the concept and that you are trying to find solutions, but without trying it myself I'm not sure I'd necessarily call it my solution. My problem is lack of exposure and experience and I already have tools to help make my first attempt more successful. What I don't have is first a higher level of first hand experience to problem solve the variety of airway problems I can run into and in my opinion that would be much more valuable. That's more of a department thing though, I realize that isn't something you can change.

My other thing is that I am not very big on intubating in many patients. Your article about first pass success with cardiac arrest is a prime example here. Most other members here already know, but my last arrest the I went with an SGA. The other medic on scene wanted to intubate, but that isn't how we or the fire departments are supposed to be doing it anymore and for good reason. We don't need to right away. 10 minutes later that guy was awake and moving, intubating would have just been more of a hassle. Throw in patients who are hypoxic, hypotensive, etc. and those are a few other reasons I wouldn't be intubating someone. If I need a quick advanced airway, it takes me all of 5 seconds to put in an igel. I can't intubate that fast.

If I had to choose equipment set up for a true difficult airway, my preference would be VL with a Kiwi grip set up. I've used VL and it was easier to find what I was looking for (not being bent over or sprawled out on the floor probably helps) and I find a bougie to be easier to manipulate in the right direction. I like your idea, but I'm not sure I'd get the same degree of flexibility in overall manipulation that I would with a VL+bougie, at least trying to picture how it would work mentally.


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## E tank (Mar 21, 2017)

Here's the thing...the primary and most frequent reason for anyone being unsuccessful in laryngoscopy and intubation is patient positioning. Meticulous detail must be paid to optimizing  and lining up the 3 columns, 2 curves or 3 axes or whatever way a person visualizes the glottis. 

I teach larygoscopy and intubation and I have well into the 5 figure range of performing them. I miss occasionally and it is because I get complacent and sloppy with what I consider an "easy" airway. Excellent positioning (shoulder roll, excellent head support, slight anterior positioning of the head, etc.) will improve the view in the vast majority of patients. Physicians whose job it is to intubate are taught this to a degree that paramedic/EMT programs just don't do. That's why they're better at it, and no novel device will make up the difference for that training. Physicians are better at intubating with VL than paramedics too for the same reason. 

Someone in another thread wondered, correctly, that for the expectations put on paramedics to intubate people, the amount of time training and continuing to train is disproportionate given other areas of expectation that they are trained in. Way more time is spent in cardiopulmonary critical care for example.  Obviously, programs will vary. 

There have been novel devices for laryngoscopy and intubation coming along for years and they all have one fatal flaw in common and that is they are made with the assumption that DL and intubation lack just enough complexity that a gimmick will fix all of the difficulty associated with it. 

The answer: train people well, and keep them trained. In my opinion, if someone doesn't perform at least one routine intubation per week when they are newly trained and once per month when a veteran, there can be no meaningful expectation for greater than a 50% success rate in a  life and death emergency. I'm sure someone will chime in with some study numbers, but that is my ancectodal experience.


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## VentMonkey (Mar 21, 2017)

E tank said:


> Here's the thing...the primary and most frequent reason for anyone being unsuccessful in laryngoscopy and intubation is patient positioning. Meticulous detail must be paid to optimizing  and lining up the 3 columns, 2 curves or 3 axes or whatever way a person visualizes the glottis.
> 
> I teach larygoscopy and intubation and I have well into the 5 figure range of performing them. I miss occasionally and it is because I get complacent and sloppy with what I consider an "easy" airway. Excellent positioning (shoulder roll, excellent head support, slight anterior positioning of the head, etc.) will improve the view in the vast majority of patients. Physicians whose job it is to intubate are taught this to a degree that paramedic/EMT programs just don't do. That's why they're better at it, and no novel device will make up the difference for that training. Physicians are better at intubating with VL than paramedics too for the same reason.
> 
> ...


Nail on the head, tank. Excellent post! Also, in your experience (you too, @Remi) how receptive are anesthesia folks to some of these newer gimmicks or devices on the whole?

Do most of you guys typically stick to what you're taught, focusing on the basics of positioning, as you've pointed out, or are they fairly receptive to these sorts of devices?


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## Ishay Benuri MD (Mar 21, 2017)

Thank you E tank. I agree with VentMonkey that it's an excellent post; but I disagree with the notion that we should close our eyes in the face of reality. Learning curve, till a practitioner reaches proficiency, will always be for any medical task even with excellent training. I do believe that nothing beats endotracheal tube for emergency scenarios (and I won’t bring studies although I have) and that if an alternative methods is chosen this is only due to the fact that the learning curve for endotracheal intubation is too slow and kills people. I believe that if Macintosh (certainly not comparing myself to him) would have decided to dedicate his career training young anesthesiologist how to use properly a straight blade, instead of introducing his curved blade, many lives would have been lost. I think that the advantage of my device is that the use of the loop is optional. If the practitioner is well trained the loop will be discarded but if he needs the small shove – the loop will be there…


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## BassoonEMT (Mar 22, 2017)

Another thing to keep in mind, the one thing that (most) higher-ups value more than patient lives is money. Unless there is a mandate, or a major lack of skill/success within the company that they can prove beyond a doubt would be resolved with your product, they will not spend the extra money. Even if it's only a few cents.


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## Ishay Benuri MD (Mar 22, 2017)

BassoonEMT said:


> Another thing to keep in mind, the one thing that (most) higher-ups value more than patient lives is money. Unless there is a mandate, or a major lack of skill/success within the company that they can prove beyond a doubt would be resolved with your product, they will not spend the extra money. Even if it's only a few cents.



I agree with you, BassiinEMT that the device must be cost effective The cost of producing SGA balloon is more expensive than a plastic lever and plastic tubing so I believe it will be more cost efficient.


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## BassoonEMT (Mar 22, 2017)

This device is certainly NOT a replacement for an SGA. You NEED a back-up airway device. Especially in the instance of RSI.
This is not a guaranteed airway device. As superior as ETI, sometimes you can't do it. There's no such thing as "eliminating the need" for another airway device. 

Does the cost of your plastic lever and plastic tubing include the engineering and adaption necessary for current manufacturers to either modify existing blades or make new ones? Machines would have to be redesigned.


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## Ishay Benuri MD (Mar 22, 2017)

BassoonEMT said:


> This device is certainly NOT a replacement for an SGA



When an anesthesiologist decides to use SGA - he usually thinks about the extubation and not of how difficult it will be to insert. - and in this case my device certainly doesn't replace SGA.

When an EMT inserts SGA - it is only because he wants to secure the airway as quickly as possible -  in this sense my device DOES replace SGA.


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## BassoonEMT (Mar 22, 2017)

I can not speak for what is done in hospital. My limited knowledge from clinicals was "they decide based on sedation and aftercare requirements."

When an Paramedic inserts an SGA, it is because they are unable to intubate. Some protocols call for using it right away, with no tube attempt. But for the most part, it is because, for whatever reason, intubation was not successful. If you emergently need to secure an airway, the reason you need to do so quickly would probably also contraindicate use of an SGA. Airway burns/swelling, aspiration, etc.

Necessity for speed is not a reason for poor patient care. 

If you need to RSI, and for whatever reason your tube is not successful, you insert a supraglottic. Blind insertion, grab the jaw and shove it in.  Airway relatively secured. Your device requires direct laryngoscopy. It does NOT replace an SGA.

Saying "you can do it quickly too" doesn't mean it replaces an SGA.


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## BassoonEMT (Mar 22, 2017)

You need a backup airway device. Your additions to a laryngoscope is not an airway device. A tube is a tube.


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## Ishay Benuri MD (Mar 22, 2017)

BassoonEMT said:


> You need a backup airway device. Your additions to a laryngoscope is not an airway device. A tube is a tube.



I agree, BassoonEMT, and therefore I am refining my previous post - I believe that the loop mechanism I propose will be helpful enough for most difficult airway that the need for SGA will drop dramatically, but SGA will remain an important backup device.


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## BassoonEMT (Mar 22, 2017)

THAT i can agree with. And you may be right.  My initial point remains though, while it may be cheaper than the SGA, that will still exist. It MAY be used less and therefore save money, but that's not a guarantee that will convince many companies.


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## Ishay Benuri MD (Mar 22, 2017)

BassoonEMT said:


> Does the cost of your plastic lever and plastic tubing include the engineering and adaption necessary for current manufacturers to either modify existing blades or make new ones? Machines would have to be redesigned




Regarding the engineering - I am adding a link to my previous invention






To manufacture these devices from scratch to a device that can be inserted into humans - the cost was about $120K

Regarding adaptation in the blades - I'll answer in the following post.


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## Ishay Benuri MD (Mar 22, 2017)

Regarding the adaptation to existing products…
	

		
			
		

		
	






One of the options considered - and this is also a reply to Grimes post at the head of the thread - to use a mounting mechanism requiring only to create slots on a blade (enabling a company to have a monoply on the product) alternatively a model capable of mounting on the tip of any blade could be used, or a complete unit - blade and loop could be sold. I can't imagine that the added unit should cost more than 1 dollar to manufacture. The blade cost should not change at all.


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## StCEMT (Mar 22, 2017)

BassoonEMT said:


> When an Paramedic inserts an SGA, it is because they are unable to intubate. Some protocols call for using it right away, with no tube attempt. But for the most part, it is because, for whatever reason, intubation was not successful.
> 
> Necessity for speed is not a reason for poor patient care.


Not necessarily. My buddy had a guy crash on him a few minutes from the hospital Sunday. Driving down busy city streets are not where I'd even consider intubating with a 4 minute ETA. SGA and be done. Speed isn't always poor patient care.

That being said, I'd be curious to try this. I think E Tank's response is more accurate for what I found to help get the best results for me personally, but that doesn't mean this doesn't offer something.


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## BassoonEMT (Mar 22, 2017)

StCEMT said:


> Not necessarily. My buddy had a guy crash on him a few minutes from the hospital Sunday. Driving down busy city streets are not where I'd even consider intubating with a 4 minute ETA. SGA and be done. Speed isn't always poor patient care.
> 
> That being said, I'd be curious to try this. I think E Tank's response is more accurate for what I found to help get the best results for me personally, but that doesn't mean this doesn't offer something.




Yes, my comment was obviously geared toward on-scene. 

And the point I was making remains, this product would not replace the SGA in that scenario either. 

I never said it was bad. But i can't see it as replacement to any existing device, even standard laryngoscopes, in the near future.


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## phideux (Mar 23, 2017)

What happens if you squeeze the handle a bit too much??? Tube lassoed to the blade??? Will the loop release if this happens????


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## Ishay Benuri MD (Mar 23, 2017)

The loop can open and close by control  of the triger. One of the safety mechanisim is release of the loop when tension is increased beyond certain level. 

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## Ishay Benuri MD (Apr 6, 2017)

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## Ishay Benuri MD (Apr 6, 2017)

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## Ishay Benuri MD (Apr 6, 2017)

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## Ishay Benuri MD (Apr 6, 2017)

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## Ishay Benuri MD (Apr 6, 2017)

Hi guys. I went over some data after I got the impression that the use of SGA is very common in the states. Can the supporters  of the SGA bring here some data contradicting what I posted?

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## E tank (Apr 6, 2017)

Where were those 10000 patients treated? Who intubated them? 4.7 % of about 8000 patients and 3.9% of about 2000 patients with "favorable" outcomes doesn't mean anything.

Some systems are very good at intubating and some are really bad. Some do it all the time and some very rarely. Data like these don't add much to the conversation if the goal is to say one is better than the other.


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## EpiEMS (Apr 7, 2017)

@Ishay Benuri MD The best data on SGA vs. ETI vs. "BLS" management (BVM with adjuncts) is an RCT, as you are probably aware. In the absence of a RCT, particularly where there is so much conflicting (and relatively low quality evidence), it really isn't clear whether ETT is superior to SGAs or BVM + adjuncts in cardiac arrest.


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