An Original Design Of Remote Robot-assisted Intubation System

ObjectiveThis study was aimed at the low success rate of pre-hospital endotracheal intubation(ETI),which was caused by lack of professional medical staff in some sites such as pre-hospital sites,battlefields,earthquake zones,overseas and aircraft carriers.To fulfill the functions of remote rescue and solve the problem of absence of specialists on the scene,we expected to develop a remote robot-assisted intubation system(RRAIS),trying to improve the success rate of pre-hospital intubation.We hoped to develop a remote robot-assisted intubation system.We expected to establish remote control system based on wireless network and improve the feasibility of the system.In addition,we will conduct a series of animal experiments to test the feasibility and possibility of the robot system.Methods1.The design of robot-assisted intubation systemThe traditional equipments for tracheal intubation must be operated manually,which seriously affects the applicability under the circumstances of the warfields and tramatic events.It is essential to design a device which is effective,portable,easy to operate and low cost.The robot-assisted intubation system would be designed based on the characteristics of airway anatomy and the concept of ergonomic design.In addition,we would design the robot according to the working way of laryngoscope and intubation system developed by foreign scientists.2.Animal experimentTwenty Bama miniature pigs bought for this study were randomly divided into laryngoscope group(n=10)and robot group(n=10).Each pig was intubated by direct laryngoscope or the robot system.Ten undergraduate medical students or postgraduate medical students,an anesthetist with eight years of working experience and several laboratory workers were enrolled in the study.Intubation time,first-attempt success rate,overall success rate,airway complications,values of systolic blood pressure(SBP),heart rate(HR)1-min before intubation and 1-min after intubation were recorded.3.Manikin experimentThe robot-assisted intubation system was applied to intubate on a manikin to test its feasibility.The time of intubation and the success rate of intubation were recorded in the experiment.4.Design of remote control systemDeveloping remote control system based on WLAN to confirm the feasibility of remote intubation based on wireless network.Results1.Three robot-assisted intubation systems were developedThree robot-assisted intubation systems were developed during the time of the project.The first generation of robot system was driven by wire rope,confirming the ability of the robot to control distal tube.However,it cannot complete the intubation for the lack of a tongue depressor,which is an indispensable component required for ETI.This generation of robot system did not comply with the requirements of the first aid and was not suitable for promotion,so we turned to the next generation of product development.The second generation of robot-assisted intubation system was added the tongue depressor some additional devices,which improved the stability and reliability of the robot system.Although the robot system was theoretically feasible,it failed in animal experiments.The reason is that the size parameters of the tongue depressor can not be adjusted,and glottis exposure can not achieve a satisfactory degree.An exclusive tongue depressor should be designed to expose the glottis.Therefore,we turned to the third generation of product development.An independent and adjustable tongue depressor was added into the the third generation of robot system,which can be more convenient to expose the glottis.The driven device of terminal tube was switched from a spring to double push rods,it can also reduce the number of motors for the system.At present,the robot system has been successfully used in the animal experiments.2.The result of animal experimentAlough there was no statistically difference,participates achieved a higher first-pass rate and overall success rate in absolute numbers by the robot system than with direct laryngoscopy(80% vs 40%,total 90% vs 60%).Although total intubation time by the robot system is longer compared with direct laryngoscopy,we found that a shorter time was consumed in the “front” by the robot system compared with direct laryngoscopy(mean 23.4 ±0.7s v 53.8±6.2s s,P<0.01).One case failed and one intubation complication occurred in robot group while four cases failed and two complications occurred in laryngoscope group.There was not a drastic fluctuation in the changes of HR and SBP in this study.3.The result of manikin experimentAt present,the robot-assisted intubation system required manual assistance to complete tracheal intubation,and some devices need to be altered before it can be used independently.4.Design of remote control systemRemote control system based on WLAN was developed successfully.The test confirmed the feasibility of remote intubation system based on wireless network.Conclusions1.We have developed three remote robot-assisted intubation systems and related supplementary devices.We also established remote control system based on local area network and improved the feasibility of the system.2.The animal experiments showed that participates achieved a higher first-pass rate and overall success rate in absolute numbers by the robot system than with direct laryngoscopy.It can significantly reduce the duration of the emergency workers' operation and did not increase the complications and hemodynamic fluctuations.The manikin experiment showed the system need to be improved now.Human trials would be conducted to test the feasibility of the system in the future.3.We hope that the remote robot-assisted intubation system can be widely applied for pre-hospital intubation and it can change the present rescue model.