TITLE:
Evaluation of Google Glass™ with Camera Adaptor and GoPro™ as Teaching Tools for Endotracheal Intubation in the Austere Medical Environment
AUTHORS:
Michael Son, David Zimmer, Ross McCauley, Donald Zimmer, Joseph Dynako, Richard Skupski, Bhavesh Patel, Nuha Zackariya, Faadil Shariff, Lovely Nathalie Colas, Gerson Pyram, Marc Edson Augustin, Carmeline Mathurin, Stanley Louis, Patricia Saint Louis, Stanley Loriston, Dan Herbstman, Lucio Cervantes, Shane Kappler, Michael T. McCurdy, Jecko Thachil, Sarah Greve, Mark Walsh
KEYWORDS:
Endotracheal Intubation, Google Glass™, GoPro™, Cord Visualization, Military Medicine, Austere Medical Environment, Low Income Country, Rural, Prehospital
JOURNAL NAME:
Open Journal of Anesthesiology,
Vol.8 No.8,
August
31,
2018
ABSTRACT: Objective: Endotracheal intubation (ETI) is a life-saving emergency procedure, but it is a complex skill that is difficult to teach. Recent studies have shown that video laryngoscopy is effective in teaching ETI to learners at various levels of medical expertise; however, it has proven to be costly and provides images of inconsistent quality. In this educational proof of concept feasibility convenience sample pilot study, we aim to explore and compare the effectiveness of using modified Google Glass™ (GG) and GoPro™ (GP) technologies to visualize and teach ETI to critical care physicians in the austere medical environment of a low-income country. We propose, based on our findings, that this inexpensive technology could teach lifesaving ETI to pre-hospital providers in the austere medical environment, medical students, rural emergency physicians, critical care physicians in low-income countries, far forward military medical providers, and other learners. Methods: A case series of twenty-five patients, five in the United States (US) at Memorial Hospital in South Bend, IN and twenty at Saint Luc’s Hospital in Port Au Prince, Haiti, is presented. These patients were collected from November 1st 2015 through February 1st of 2016. The anesthesiologist and the emergency physicians in the United States utilized GG to intubate five patients in the US prior to the twenty patients intubated during two separate trips to Haiti. On the two separate trips to Haiti, the GG was trialed and modified to obtain better exposure. These adaptations resulted in the final collection of twenty patients studied with the adapted GG system and GP. Physicians graded airway visualization based on LEMON and Cormack-Lehane scores. Previously published parameters for the assessment of failed intubation risk and passage of the cords were used as data points for analysis using a Likert-Scale analysis for each parameter. The data were analyzed by averages of Likert-Scale scoring with their respective standard deviations. Results: The results show that the GP is superior to GG for assessing the LEMON scoring system until visualization of the oropharynx, while the GG is markedly superior for calculation of Cormack-Lehane score (cord visualization) and passing of the endotracheal tube. Conclusion: A review of the twenty-five cases demonstrates that while GP allows for better visualization for the parameters that require a wider view of the patient, the modified GG allows for superior visualization in the parameters that require a more focused view of the cords. GG can serve as an effective educational tool in the ICU for physicians and other providers in the austere medical environment who require effective ETI training. In addition, we propose that these techniques can serve as an inexpensive yet effective means of teaching hands on endotracheal intubation skills to learners of varying levels of clinical experience.