Teaching Fiberoptic Intubation Skills with an iPhone Application: a Randomized Controlled Trial
Abstract Number: S-8
Abstract Type: Original Research
Introduction: The CEMACH study(2006-2008) reports three maternal airway deaths. A recent survey in the UK revealed that 8% of obstetrical units had a designated fiberoptic bronchoscope, only 37% of anesthetists felt proficient using the device(up from 8% in the previous decade) Our application, iLarynx, addresses this problem.
Methods: The program was created using the Unity 3D Game Engine to simulate the view from a fiberoptic bronchoscope moving through the larynx. The iPhone’s built-in accelerometers are used to duplicate the turning of a fiberscope, which can be performed by rotating the phone, to align the laryngeal inlet. The device’s multi-touch screen is utilized to allow thumb-control over the deflection of the tip, while the opposing hand moves the virtual bronchoscope is into the trachea. There are no set pathways. The user must navigate around the uvula and under the epiglottis to have a view of the vocal cords. Twenty medical students were randomly assigned to receive either a 20 minute didactic lecture on airway anatomy with static views or were given an iPad running the iLarynx application. Both groups were then given a real bronchoscope and time to successful intubation on a standardized airway manikin was recorded by a blinded observer. Airway manikins are used routinely to test medical students, paramedics,and residents on intubation skills because manikins eliminate the variability in human anatomy. Statistical analysis included the following: Fisher exact test for categorical data, Mann-Whitney U test for time to intubation and Global Rating Score on a five point scale.
Results: (see figure) success/failure: 4/6 for the didactic group, 9/1 for the iLarynx p<.05. Intubation time: 100secs for the didactic group,35secs for the iLarynx p<.004. GRS : 1 for the didactic,3 for the iLarynx p< .02.
Discussion: Several leading professional-grade video game engines have adapted their toolset to support the development of AAA-class consumer games on the iPhone platform. The iLarynx application enables a generation of anesthesiologists familiar with video games to develop the necessary hand- eye co-ordination skills for successful fiberoptic intubation. Attendance at airway workshops cost $500, airway mannequins $2000, virtual reality simulators $50,000. Over two thousand iLarynx applications were distributed world- wide through the iPhone app store making this a popular and cost-effective virtual reality airway simulator.