A novel approach to evaluate skills in Endotracheal Intubation using biomechanical measurement system

Endotracheal Intubation (ETI) is a common airway procedure used to connect the larynx and the lungs through the windpipe of patients under emergency situations. The process is carried out by a laryngoscope inserted into the mouth, and helps doctors in viewing the glottis and inserting the tube. In 2012, we developed a humanoid robot for ETI training, called WKA-5R, which was able to simulate various patients and scenarios and to evaluate the doctor's medical skills according to applied force, position of laryngoscopes and tubes, and procedure time. In 2013, we have focused our study on the development of a system for the biomechanical evaluation during simulated ETI. We conducted an experiment with 5 expert and 6 novice anesthesiologists and measured 3 biomechanical parameters: angular velocity of wrist joint and elbow joint, surface electromyography (sEMG) of the upper limb, and some angles on the upper part of the body, in order to evaluate joint stiffness in the arm and posture during ETI. In this paper, the authors show the experimental results on comparison between experts and novices, followed by discussion.

[1]  Jessica K. Hodgins,et al.  Multimodal feature analysis for quantitative performance evaluation of endotracheal intubation (ETI) , 2012, 2012 IEEE International Conference on Acoustics, Speech and Signal Processing (ICASSP).

[2]  G. D. P. M. DipTP Introduction to Surface Electromyography , 1998 .

[3]  Salvatore Sessa,et al.  Biomechanical evaluation of the phases during simulated Endotracheal Intubation (ETI): Pilot study on the effect of different laryngoscopes , 2013, 2013 35th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC).

[4]  M. Garcia‐Elias,et al.  Role of the extensor carpi ulnaris and its sheath on dynamic carpal stability , 2012, The Journal of hand surgery, European volume.

[5]  Adam de Laveaga,et al.  Ergonomics of novices and experts during simulated endotracheal intubation. , 2012, Work.

[6]  Ozawa Shinji,et al.  A measurement of driver's behavior and a proposal of evaluation index of driver's concentration , 2010 .

[7]  M. Hubble,et al.  A Meta-Analysis of Prehospital Airway Control Techniques Part I: Orotracheal and Nasotracheal Intubation Success Rates , 2010, Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors.

[8]  Makoto Hashizume,et al.  Objective Skill Evaluation for Laparoscopic Training Based on Motion Analysis , 2013, IEEE Transactions on Biomedical Engineering.

[9]  P. Pepe,et al.  Prehospital endotracheal intubation: rationale for training emergency medical personnel. , 1985, Annals of emergency medicine.

[10]  Salvatore Sessa,et al.  Baseline Adaptive Wavelet Thresholding Technique for sEMG Denoising , 2011 .

[11]  Salvatore Sessa,et al.  Development of the wireless ultra-miniaturized inertial measurement unit WB-4: Preliminary performance evaluation , 2011, 2011 Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[12]  J. Stauffer,et al.  Complications and consequences of endotracheal intubation and tracheotomy. A prospective study of 150 critically ill adult patients. , 1981, The American journal of medicine.

[13]  Shinichi Furuya,et al.  Organization of the upper limb movement for piano key-depression differs between expert pianists and novice players , 2008, Experimental Brain Research.

[14]  Salvatore Sessa,et al.  A Methodology for the Performance Evaluation of Inertial Measurement Units , 2013, J. Intell. Robotic Syst..

[15]  Chunbao Wang,et al.  Development of the airway Management Training System WKA-5: Improvement of mechanical designs for high-fidelity patient simulation , 2012, 2012 IEEE International Conference on Robotics and Biomimetics (ROBIO).

[16]  M. Mochimaru,et al.  Foot Pressure, Ground Reaction Force and 3D Motion Analysis of Golf Swing Applied to Spikeless Golf Shoe Development , 2010 .

[17]  L. Gugino,et al.  A clinical sign to predict difficult tracheal intubation: a prospective study. , 1986, Canadian Anaesthetists' Society journal.