Monday, October 18, 2021

Students devise a tracheotomy device for soldiers


A team of students at Johns Hopkins University in Baltimore invented a device that could help medics on the battlefield clear any obstructions in the airways of injured soldiers and, they hope, save those soldiers’ lives, the Baltimore Sun reports.

The team is led by Antonio Spina, a 2016 graduate from Streamwood, Illinois. Ronak Mehta from New Jersey, Qiuyin Ren from Massachusetts, Jordan Kreger from Michigan, Ryan Walter from Florida, Sondra Rahmeh from Texas, Himanshu Dashora from Ohio, Travis Wallace from Connecticut, and Michael Good from North Carolina are also on this team of designers who say the needs of the military inspired them to develop their handheld emergency cricothyrotomy assist device, which they have called the “Cricspike.”

It’s a kit, actually, designed to be fool-proof, inexpensive, and light—features that make it more reliable and user-friendly on a battlefield. The Cricspike has two low-tech parts: a specially shaped tip and a break-apart handle. When a soldier’s airway gets blocked, say by a jaw fracture in an explosion, a dire situation arises in which the path for air from the mouth to the lungs becomes completely blocked.

Johns Hopkins CricSpike cricothyrotomy assist device
Factors that limit the success of the procedure in battle (CricSpikeTM team website)

Medics can’t get oxygen to the soldier’s lungs, resulting in a status known as “can’t ventilate, can’t intubate,” or CVCI, and they have to perform a surgical cricothyrotomy, cutting open the throat and windpipe with a scalpel and inserting a tube through the surgical incision in order to bypass the obstruction and allow air to flow to the lungs.

This procedure occurs about twice as often in the military as in civilian life, yet military medics, who are trained EMTs, fail three to five times more frequently than civilian EMTs. Part of the problem is that careful handling is required to direct the tube properly into the trachea. EMTs may not have the dexterity, which involves gripping the tube like a pencil in most cases, or battlefield chaos may not be conducive to the procedure.

But that’s just the inspiration. The procedure fails in civilian life as well, mostly because of time constraints (EMTs have about five minutes or less to clear a patient’s airway before the chances of survival drop off precipitously) or improper placement of the tube (doing it fast in an emergency sometimes causes the tube to be inserted just under the skin or into the esophagus, which goes to the stomach and won’t help with the oxygen situation).

The team’s design uses a blunt-tipped, plastic piece with a hollow channel in the center. This gets inserted into the trachea, but it can’t puncture the back of the trachea and get to the esophagus. This design feature covers the common error of EMTs inserting the tube into the esophagus. Other design features, including a break-apart, easy-to-grip-and-guide handle, make sure the tube is properly inserted into the trachea as well. The entrance port of this piece points straight up and can be hooked up directly to a ventilator or have a plastic breathing tube inserted if one is available. The exit port faces horizontally and directs the incoming air to the lungs.

The team addressed the problems with a novel design for performing cricothyrotomies.

Most important, the device simply reduces the opportunity for mistakes by the EMTs or field medics; they only have to use their elbows, not their fingers so much, to insert the device properly. The prototype still needs a bit of work, but it has promise, the Sun quoted retired US Army physician James K Gilman as saying. He’s the former executive director of the Johns Hopkins Military and Veterans Health Institute and the students’ sponsor and medical adviser.

Paul Katula
Paul Katula is the executive editor of the Voxitatis Research Foundation, which publishes this blog. For more information, see the About page.

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