Airway Management: Review of Current Devices and Development of a Novel Endotracheal Tube for Emergency Combat Care

The current gold standard for combat airway management is endotracheal intubation however, the performance of the current design, endotracheal tube (ETT), is highly inadequate. The expansion mechanism causes regions of concentrated stress leading downstream complications for the patient. Although the limitations of endotracheal intubation have been widely studied, there has not been significant technological improvements to the design of the ETT. Supraglottic airway (SGA) devices have shown to be easier and faster to use than ETTs. However, no testing has been done on SGA devices to examine their robustness in a military environment. This thesis presents an overview of commercially available SGA devices to determine which devices should be tested according to military standards. It was hypothesized that by testing SGA devices according to military standards determine which devices should be preferred and avoided in combat emergency care. The advantages of SGA devices led to develop a novel endotracheal tube that replaces the standard inflatable cuff. The proposed design is a novel endotracheal tube system (NETS) that replaces the cuff with a mechanical expanding system. It was hypothesized that NETS can lower the max pressure exerted onto the trachea with a higher max dislodgement force and seal performance than that of the standard ETT. Comparative testing was conducted between NETS and the standard ETT to determine the leak performance, dislodgement force, and pressure exerted to the trachea. Results showed that NETS lowers the max pressure with a higher max dislodgement but lacks the ability to create a fluid tight seal.