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Session: Poster session II
Session starts: Thursday 24 January, 16:00

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Julie Fleischer (Delft University of Technology)
Linda Wauben (Delft University of Technology)
Jan Klein (Delft University of Technology)
Jenny Dankelman (Delft University of Technology)

Abstract:
Introduction: Difficult intubation is a well-known clinical problem that is most often encountered in emergency medical settings, but it also complicates airway management in intensive care units and operating theatres. Difficult intubations are associated with complications, such as trauma, hoarseness and hypoxia. Videolaryngoscopy can reduce intubation time, increase first-pass success rate and reduce the number of oesophageal intubations. However, videolaryngoscopes are not widely used in low- and middle-income countries (LMIC), increasing the risk of complications and possibly making difficult intubation an obstacle to perform surgery. Therefore, this study identifies barriers to videolaryngoscopy in LMIC as well as stakeholders’ needs and generates design requirements for a new context-specific design. Method: Twenty-seven questionnaires were returned by surgeons, anaesthesiologists, biomedical engineers, sterilisation department employees and other healthcare professionals attending the 2018 Surgical Society of Kenya Conference and 30 questionnaires were returned from three hospitals in Kenya. Current practice concerning use and maintenance of airway equipment was observed for two days in a Kenyan hospital and non-structured interviews were done with stakeholders from multiple institutions in Kenya. Moreover, a literature search was performed to compare performance of various videolaryngoscope designs. Based on these requirements a reusable videolaryngoscope was developed. Results: Barriers to widespread use of videolaryngoscopy in Kenya include high procurement costs, difficulty in obtaining disposables or proprietary spare parts and unfamiliarity with the equipment. The most important design requirements include easy manoeuvrability and a short learning curve so that it can be used by experienced and inexperienced providers in all settings, as well as the possibility for local repair. A design was created that accommodates both standard and hyper-angulated blades to manage various patient anatomies. This multi-blade videolaryngoscope combines a low-cost USB endoscope with a smartphone screen. Discussion & conclusion: The identified barriers and design comparison led to a prototype for a low-cost and easy to use videolaryngoscope. The next steps include a functional evaluation for direct and indirect laryngoscopy of the blades, an analysis of the light source and image quality and an assessment of maintenance and cleaning procedures in the local context, resulting in a device that could increase use of videolaryngoscopy in LMIC.