Author(s)

Michael Son^1,2, David Zimmer^3*, Ross McCauley³, Donald Zimmer², Joseph Dynako³, Richard Skupski², Bhavesh Patel⁴, Nuha Zackariya⁵, Faadil Shariff⁵, Lovely Nathalie Colas⁶, Gerson Pyram⁶, Marc Edson Augustin⁶, Carmeline Mathurin⁶, Stanley Louis⁶, Patricia Saint Louis⁶, Stanley Loriston⁷, Dan Herbstman⁸, Lucio Cervantes⁹, Shane Kappler¹⁰, Michael T. McCurdy¹⁰, Jecko Thachil¹¹, Sarah Greve², Mark Walsh^2,3,12

¹University of Notre Dame, Notre Dame, IN, USA.
²Memorial Hospital, South Bend, IN, USA.
³Indiana University School of Medicine, South Bend, IN, USA.
⁴Mayo Clinic, Phoenix, AZ, USA.
⁵Indiana University Bloomington, Bloomington, IN, USA.
⁶H?spital Saint Luc, Port-Au-Prince, Haiti.
⁷Department of Anesthesiology, H?pital Universitaire Justinien, Cap Ha?tien, Haiti.
⁸Third Eye Health, Chicago, IL, USA.
⁹Adisat Colonia: Condessa, Mexico City, Mexico.
¹⁰University of Maryland School of Medicine, Baltimore, MD, USA.
¹¹Department of Haematology, Manchester Royal Infirmary, Manchester, UK.
¹²St Joseph Regional Medical Center, Mishawaka, IN, USA.

Objective: Endotracheal intubation (ETI) is a life-saving emergency procedure, but it is a complex skill that is difficult to teach. Recent studies have shown that video laryngoscopy is effective in teaching ETI to learners at various levels of medical expertise; however, it has proven to be costly and provides images of inconsistent quality. In this educational proof of concept feasibility convenience sample pilot study, we aim to explore and compare the effectiveness of using modified Google Glass™ (GG) and GoPro™ (GP) technologies to visualize and teach ETI to critical care physicians in the austere medical environment of a low-income country. We propose, based on our findings, that this inexpensive technology could teach lifesaving ETI to pre-hospital providers in the austere medical environment, medical students, rural emergency physicians, critical care physicians in low-income countries, far forward military medical providers, and other learners. Methods: A case series of twenty-five patients, five in the United States (US) at Memorial Hospital in South Bend, IN and twenty at Saint Luc’s Hospital in Port Au Prince, Haiti, is presented. These patients were collected from November 1^st 2015 through February 1^st of 2016. The anesthesiologist and the emergency physicians in the United States utilized GG to intubate five patients in the US prior to the twenty patients intubated during two separate trips to Haiti. On the two separate trips to Haiti, the GG was trialed and modified to obtain better exposure. These adaptations resulted in the final collection of twenty patients studied with the adapted GG system and GP. Physicians graded airway visualization based on LEMON and Cormack-Lehane scores. Previously published parameters for the assessment of failed intubation risk and passage of the cords were used as data points for analysis using a Likert-Scale analysis for each parameter. The data were analyzed by averages of Likert-Scale scoring with their respective standard deviations. Results: The results show that the GP is superior to GG for assessing the LEMON scoring system until visualization of the oropharynx, while the GG is markedly superior for calculation of Cormack-Lehane score (cord visualization) and passing of the endotracheal tube. Conclusion: A review of the twenty-five cases demonstrates that while GP allows for better visualization for the parameters that require a wider view of the patient, the modified GG allows for superior visualization in the parameters that require a more focused view of the cords. GG can serve as an effective educational tool in the ICU for physicians and other providers in the austere medical environment who require effective ETI training. In addition, we propose that these techniques can serve as an inexpensive yet effective means of teaching hands on endotracheal intubation skills to learners of varying levels of clinical experience.

Endotracheal Intubation, Google Glass™, GoPro™, Cord Visualization, Military Medicine, Austere Medical Environment, Low Income Country, Rural, Prehospital

Son, M. , Zimmer, D. , McCauley, R. , Zimmer, D. , Dynako, J. , Skupski, R. , Patel, B. , Zackariya, N. , Shariff, F. , Colas, L. , Pyram, G. , Augustin, M. , Mathurin, C. , Louis, S. , Louis, P. , Loriston, S. , Herbstman, D. , Cervantes, L. , Kappler, S. , McCurdy, M. , Thachil, J. , Greve, S. and Walsh, M. (2018) Evaluation of Google Glass™ with Camera Adaptor and GoPro™ as Teaching Tools for Endotracheal Intubation in the Austere Medical Environment. Open Journal of Anesthesiology, 8, 229-239. doi: 10.4236/ojanes.2018.88024.