Airway obstruction is the second most common cause of preventable death in combat situation and combat medics fail at this procedure 33% of the time. To prevent early military death and to help treat these types of injuries, a team of Johns Hopkins undergraduate students has designed a low-cost, low-tech device named CricSpike that can elevate the chances of positive health outcomes when combat medics need to create an artificial airway and pump air into the lungs. The goal of this procedure is to keep wounded soldiers alive until more advanced treatment can be administered at a hospital.
In their research, the undergrad team discovered that combat medics in the battlefield who attempt the emergency neck-incision tactic, known as a cricothyrotomy, are unsuccessful about one-third of the time. Even physicians and assistants failed about 15% of the time in hospital settings.
In recent American military conflicts in countries such as Iraq and Afghanistan, 10-15% of the preventable battlefield deaths were due to airway obstructions or respiratory failure. Military experts say more lives could be saved and military casualties could be prevented if better battlefield cricothyrotomy techniques were implemented.
The team designed their CricSpike prototype with a special focus towards simplifying and speeding up the procedure, and improving the accuracy of the insertion. One of the major issues that the undergrads realized was that the tools typically used in battle zones often do not manage to connect to the patient’s trachea, more commonly known as the windpipe.
They discovered that these tools get stuck just under the patient’s skin or bypass the trachea altogether and instead hit the esophagus, which leads to the stomach instead of lungs.
To facilitate this, the students engineered this device with an improved intra-tracheal tip, removable handle, and a tracheal balloon stent. It is different from other cricothyrotomy devices since it allows to go directly into the trachea instead of sub-cutaneous layers, hence it extends beyond the skin layers but not far enough to the esophagus. After the tip has been inserted, the handle breaks off, allowing to insert the tube to which the balloon is attached. The balloon is pressed to pump air into the lungs.
For demonstration purposes, the student inventors have packaged the CricSpike tip and its handle as part of a kit that also includes a scalpel to make the neck incision and an endotracheal tube to channel air to the windpipe.
In demonstrations with a medical dummy and animal tissue, the students have proven that their prototype does function as intended. The medical device will require further testing and many cycles of refinement before it can be used reliably in battle zones on human subjects. Despite the device being far from perfect, it has already won two awards.
The early prototype was awarded second prize in the student project category at the Innovation Research Lab Exhibition, presented at the Central Institute of Healthcare Engineering of Friedrich-Alexander University in Erlangen, Germany, in July. In May, the team received a third-place prize in the 2016 Johns Hopkins Student Healthcare Design Competition, organized by the university’s Center for Bioengineering Innovation and Design.
Additionally, the students have worked with the staff of Johns Hopkins Technology Ventures to obtain a provisional patent covering the design of their CricSpike components. “The students did a great job,” said Gilman, the project’s sponsor. “But the final prototype was still pretty rough. Relying on 3D printing techniques could only get them to a certain level. The next step in the development process would have to involve production of a more professional prototype.”
How Does Cricothyrotomy Work?
Cricothyrotomy is a procedure in which an incision is made on a patient’s neck just above the Adam’s apple during life threatening situations. It allows for an airway passage to be established during extreme scenarios such as obstruction by a foreign object or facial trauma.
Cricothyrotomy is usually performed as a last ditch method when an intubation can’t be performed in a person’s mouth due to clenched teeth, tumors present in mouth or massive bleeding. It is easier to perform compared to standard intubation techniques, and is vital to prevent fatalities through asphyxiation.
A word of caution, cricothyrotomy should always be performed by experienced individuals or medical professionals, since a novice could ill-adversely harm the patient. Also, the procedure should not be performed on young individuals, particularly in kids under the age of 10. For this age group needle cricothyrotomy can be performed which uses a large over-the-needle catheter instead of a scalpel incision. Since the cut is small, a high pressured gas source is needed to supply oxygen.
This is not the first time when some medical equipment has been made specifically for military personnel. The Defense Advanced Research Projects Agency (DARPA) developed a mind controlled bionic arm for army veterans that is able to set up a communication pathway with the brain, possessing a lifelike appearance and human like strength and dexterity.
Moreover, the bionic arm contains sensors in its fingertips, which are able to detect different textures, temperatures and pressure. And that’s exactly what we need: innovation in the field of medicine.