ETView, new integrated video intubation

[Ender]

I came across this today and as a basic student wanted thoughts from those who have actually done intubation. An Israeli company, ETView, just got a distribution deal for their ET tube that has an integrated video camera. It plugs to a laptop by USB and costs $120. Obviously this is pretty expensive for something you could get for $2 but since it lets placement be verified, and re-verified easily any time needed, it at least has value in a hospital setting rather than X-ray verification. I wondered what thoughts were on prehospital use though, in difficult intubations at least. They mention its use to re-verify placement after movement in operations, but perhaps too after extracations? It seems like even beyond making difficult intubations easier and more certain it would let the ER plug in and satisfy themselves with placement, and monitor it through any operations needed.

article about their distibution deal: http://www7.medica.de/cipp/md_medica/custo...icket,g_u_e_s_t

company website: http://www.etview.com/

Josh

[Ridryder 911]

You shopuld be confirming ETI with capnography... this is the only legal true documentation. Otherwise there is no verification of displacement and continous ventillation.

R/R 911

[Nate]

We have looked into fiber optic systems to intubate those "hard" patients, but I have to agree with Rid.

[AZCEP]

Capnography isn't the only true confirmation, gents.

Revisualization, esophageal detection devices, colorimetric EtCO2, auscultation of lung sounds are all viable methods of confirming tube placement. In the breathing patient, the use of a BAAM whistle will confirm placement better than any other method.

Capnography/capnometry is still a secondary confirmation of ET placement. Yes it is a very good one, but it is still just a secondary method. Even with the moving of a patient, you can use the other methods. You just have to make sure that they are done following every move. Better yet, place the patient in spinal precautions and eliminate some of the risk.

For the fiber-optic tube, there must be more than a dozen different types of fiber-optic systems already available. The major hang up with all of them is cost, followed closely by durability. You really don't want a prehospital provider taking a $15,000 piece of equipment into a scene and destroying it, now do you.

[flight-lp]

What will they think of next? This is just like the Auto Pulse thread, lets stop wasting time and money on these "toys" and focus on Medics actually performing their jobs correctly. Why spend $120 on this thing, when a Medic, for free mind you, can 1. visualize the ETT passing through the cords, 2. confirm with ETCO2, 3. confirm with an increase in SPO2, and 4. confirm with the presence of bilateral breath sounds.

[emt3225]

What will they think of next? This is just like the Auto Pulse thread, lets stop wasting time and money on these "toys" and focus on Medics actually performing their jobs correctly. Why spend $120 on this thing, when a Medic, for free mind you, can 1. visualize the ETT passing through the cords, 2. confirm with ETCO2, 3. confirm with an increase in SPO2, and 4. confirm with the presence of bilateral breath sounds.

Soon we wont have any jobs because someone will invent a robot to do what we are doing now..Lets spend the money for trainings and better education for medics and emts.. :wink:

[Ender]

Now, I will admit that new technology ideas have always caught my attention pretty easily to at least look into, and there are certainly plenty of things that only really add complication to things. At times, though, there is some value in the right situation. You can't just take any higher level of complication as always bad. I would agree that with the autopulse, it adds expense every time you use it on top of the high initial cost and doesn't really add any options you don't have without it.

The thing I thought might have some value is that it might open a new option sometimes. Not having experience with it I wanted to see if anyone else agreed that it might have some worth. A $15,000 fiber optic scope really is just another barely used thing to train on for that one time you use it and try not to break. If nothing else, though, the ETView at $120 to sit around and only needing to plug it into the barely used laptop when you need it on a difficult airway seems it could be of enough benefit. As far as the other methods to check placement yeah, but would it be bad to be sure without needing to check on that difficult placement when every bit of time you take to check and possibly redo the intubation matters? Can you always see the tube pass the vocal cords when the patient is on a backboard or pinned somewhere? If you are confirming placement by results of a proper breath, you leave the chance of having to replace the tube if you don't get that positive response and may waste time that may make a difference. Also it would allow you be certain you avoid bronchial intubation, or easily check for it if the patient is jostled.

For AZCEP, the thing about this tube compared to those fiber optic ones is the tube itself is $120, but it just plugs into any computer to view by a USB plug and at least with the service I ride with, laptops are always carried already to file reports on. There isn't that expensive extra equipment as the micro-camera is built into the tube itself.

I'm not saying that maybe it isn't ever worth the cost. I haven't actually done it and don't know what complications there might really be. Responses simply dismissing it as another gadget though don't say anything of use.

[flight-lp]

If you have time to hook up this gadget to a laptop and then open the program to view the image, then you are overlooking something. $120 is PER ETT. Consider we carry on average of 15 in the airway kit, plus a resupply on the truck, that cost adds up quick! Not to mention they are not reusable! Direct visualization is easier, quicker, and cheaper. ETCO2 is more clinically accurate method of confirmation. And I was completely turned away by a statement on their website indicating that a chest x-ray is no longer needed with this device. Not to mention the possibility of camera obscurity should fluid, vomit, or anything else block the view. Oh yeah, one more, you couldn't use it in many helicopter based services due to FAA regulations concerning portable electronic devices...............

Sorry, its an interesting idea, but one that is not practical in EMS.

[Ender]

I certainly wasn't thinking it would replace normal ET Tubes, I was thinking more along the lines of a single one around if the case arose, but yeah I see the problems you mention.