Citations

3rd most common medical procedure in the US, with over 30 Million performed each year.

“Quantifying the Complications and Impact of Persistent Intubation Problems, Runnels 2018”

  • 1. Harris K. Endotracheal tube exchangers: should we look for safer alternatives? Heart Lung, 201;41(1):67-9
  • 2. DeAlmeida,JP. Bronchial injury and pneumothorax after reintubation using an airway exchange catheter. Braz J Anesthesiol, 2013;63(1);107-9
  • 3. Sheron McLean. Airway Exchange Failure and Complications with the Use of the Cook Airway Exchange Catheter®: A Single Center Cohort Study of 1177 Patients. Anesth Analg 2013;117:1325–7

The cost of intubation complications is over $5 billion in increased medical care.

“Estimating the Economic and Absolute Number of Complications Associated with Emergency Intubations Performed Outside the Operating Room; A Methodology for Estimating the Burden in the United States, Runnels 2019”

  • Mort TC. Emergency Tracheal Intubation: Complications Associated with Repeated Laryngoscopic Attempts. Anesth Analg. 2004;99(2):607-613. doi:10.1213/01.ANE.0000122825.04923.15
  • Sakles JC, Chiu S, Mosier J, Walker C, Stolz U. The importance of first pass success when performing orotracheal intubation in the emergency department. Acad Emerg Med. 2013;20(1):71-78. doi:10.1111/acem.12055.The
  • Martin LD, Mhyre JM, Shanks AM, Tremper KK, Kheterpal S. 3,423 Emergency Tracheal Intubations at a University Hospital. Anesthesiology. 2011;114(1):42-48. doi:10.1097/aln.0b013e318201c415
  • Hasegawa K, Shigemitsu K, Hagiwara Y, et al. Association Between Repeated Intubation Attempts and Adverse Events in Emergency Departments: An Analysis of a Multicenter Prospective Observational Study. Ann Emerg Med. 2012;60(6):749-754.e2. doi:10.1016/j.annemergmed.2012.04.005
  • Hasegawa K, Hagiwara Y, Imamura T, et al. Increased incidence of hypotension in elderly patients who underwent emergency airway management: An analysis of a multi-centre prospective observational study. Int J Emerg Med. 2013;6(1):1-8. doi:10.1186/1865-1380-6-12
  • Rognås L, Hansen TM, Kirkegaard H, Tønnesen E. Pre-hospital advanced airway management by experienced anaesthesiologists: A prospective descriptive study. Scand J Trauma Resusc Emerg Med. 2013;21(1):1-10. doi:10.1186/1757-7241-21-58
  • Kim J, Kim K, Kim T, et al. The clinical significance of a failed initial intubation attempt during emergency department resuscitation of out-of-hospital cardiac arrest patients. Resuscitation. 2014;85(5):623-627. doi:10.1016/j.resuscitation.2014.01.017
  • Duggan LV, K.S. M, Griesdale DE, et al. Complications increase with greater than one endotracheal intubation attempt: experience in a Canadian adult tertiary-care teaching center. J Clin Anesth. 2014;26(2):167. doi:10.1016/j.jclinane.2013.12.005
  • Chi JH, Knudson MM, Vassar MJ, et al. Prehospital hypoxia affects outcome in patients with traumatic brain injury: A prospective multicenter study. J Trauma - Inj Infect Crit Care. 2006;61(5):1134-1141. doi:10.1097/01.ta.0000196644.64653.d8
  • Spaite DW, Hu C, Bobrow BJ, et al. Association of Out-of-Hospital Hypotension Depth and Duration With Traumatic Brain Injury Mortality. Ann Emerg Med. 2017;70(4):522-530.e1. doi:10.1016/j.annemergmed.2017.03.027
  • Park L, Zeng I, Brainard A. Systematic review and meta-analysis of first-pass success rates in emergency department intubation: Creating a benchmark for emergency airway care. EMA - Emerg Med Australas. 2017;29(1):40-47. doi:10.1111/1742-6723.12704
  • Rui P, Hing E, Okeyode T. National Ambulatory Medical Care Survey : 2008 Summary Tables.; 2014. http://www.cdc.gov/nchs/ahcd/ahcd_products.htm.
  • Pfuntner A, Wier LM, Stocks C. Most Frequent Procedures Performed in U.S. Hospitals, 2011: Statistical Brief #165. Vol 2011.; 2006. https://www.hcup-us.ahrq.gov/reports/statbriefs/sb165.pdf.
  • Frost & Sullivan. U.S. Anesthesia and Respiratory Products Markets.; 2003. http://www.frost.com/prod/servlet/report-overview.pag?repid=A393-01-00-00-00.
  • Mathers CD, Ezzati M, Lopez AD. Measuring the burden of neglected tropical diseases: The global burden of disease framework. PLoS Negl Trop Dis. 2007;1(2). doi:10.1371/journal.pntd.0000114
  • Meara JG, Leather AJM, Hagander L, et al. Global Surgery 2030: Evidence and solutions for achieving health, welfare, and economic development. Lancet. 2015;386(9993):569-624. doi:10.1016/S0140-6736(15)60160-X
  • Rugulies R, Ando E, Ayuso-Mateos JL, et al. WHO/ILO work-related burden of disease and injury: Protocol for systematic reviews of exposure to long working hours and of the effect of exposure to long working hours on depression. Environ Int. 2019;125(November):515-528. doi:10.1016/j.envint.2018.11.011
  • Bernhard M, Becker TK, Gries A, Knapp J, Wenzel V. The First Shot Is Often the Best Shot. Anesth Analg. 2015;121(5):1389-1393. doi:10.1213/ane.0000000000000891
  • Lascarrou JB, Boisrame-Helms J, Bailly A, et al. Video Laryngoscopy vs Direct Laryngoscopy on Successful First-Pass Orotracheal Intubation Among ICU Patients. JAMA. 2017;317(5):483. doi:10.1001/jama.2016.20603
  • Rinderknecht AS, Dyas JR, Kerrey BT, Geis GL, Ho MH, Mittiga MR. Studying the Safety and Performance of Rapid Sequence Intubation: Data Collection Method Matters. Newgard C, ed. Acad Emerg Med. 2017;24(4):411-421. doi:10.1111/acem.13145
  • Spaite DW, Hu C, Bobrow BJ, et al. The Effect of Combined Out-of-Hospital Hypotension and Hypoxia on Mortality in Major Traumatic Brain Injury. Ann Emerg Med. 2017;69(1):62-72. doi:10.1016/j.annemergmed.2016.08.007
  • Spaite DW, Bobrow BJ, Keim SM, et al. Association of Statewide Implementation of the Prehospital Traumatic Brain Injury Treatment Guidelines With Patient Survival Following Traumatic Brain Injury. JAMA Surg. May 2019:e191152. doi:10.1001/jamasurg.2019.1152
  • Diggs LA, Yusuf J-E (Wie), De Leo G. An update on out-of-hospital airway management practices in the United States. Resuscitation. 2014;85(7):885-892. doi:10.1016/j.resuscitation.2014.02.032
  • Bernhard M, Bax SN, Hartwig T, et al. Airway Management in the Emergency Department (The OcEAN-Study) - a prospective single centre observational cohort study. Scand J Trauma Resusc Emerg Med. 2019;27(1):20. doi:10.1186/s13049-019-0599-1
  • Taboada M, Doldan P, Calvo A, et al. Comparison of Tracheal Intubation Conditions in Operating Room and Intensive Care Unit. Anesthesiology. 2018;129(2):321-328. doi:10.1097/ALN.0000000000002269
  • Casey JD, Janz DR, Russell DW, et al. Bag-Mask Ventilation during Tracheal Intubation of Critically Ill Adults. N Engl J Med. 2019;380(9):811-821. doi:10.1056/NEJMoa1812405
  • De Jong A, Rolle A, Molinari N, et al. Cardiac Arrest and Mortality Related to Intubation Procedure in Critically Ill Adult Patients. Crit Care Med. 2018;46(4):532-539. doi:10.1097/CCM.0000000000002925
  • Boyce JM, Potter-Bynoe G, Dziobek L. Nosocomial Pneumonia in Medicare Patients. Arch Intern Med. 1991;151(6):1109. doi:10.1001/archinte.1991.00400060053009
  • Siddique R, Neslusan CA, Crown WH, Crystal-Peters J, Sloan S, Farup C. A national inpatient cost estimate of percutaneous endoscopic gastrostomy (PEG)-associated aspiration pneumonia. Am J Manag Care. 2000;6(4):490-496. https://www.ajmc.com/journals/issue/2000/2000-04-vol6-n4/apr00-635p490-496.
  • Warren DK, Shukla SJ, Olsen MA, et al. Outcome and attributable cost of ventilator-associated pneumonia among intensive care unit patients in a suburban medical center*. Crit Care Med. 2003;31(5):1312-1317. doi:10.1097/01.CCM.0000063087.93157.06
  • Katzan IL, Dawson N V., Thomas CL, Votruba ME, Cebul RD. The cost of pneumonia after acute stroke. Neurology. 2007;68(22):1938-1943. doi:10.1212/01.wnl.0000263187.08969.45
  • Tong S, Amand C, Kieffer A, Kyaw MH. Trends in healthcare utilization and costs associated with acute otitis media in the United States during 2008–2014. BMC Health Serv Res. 2018;18(1):318. doi:10.1186/s12913-018-3139-1
  • Olasupo O, Xiao H, Brown J. Relative Clinical and Cost Burden of Community-Acquired Pneumonia Hospitalizations in Older Adults in the United States—A Cross-Sectional Analysis. Vaccines. 2018;6(3):59. doi:10.3390/vaccines6030059
  • Kolte D, Khera S, Aronow WS, et al. Regional Variation in the Incidence and Outcomes of In-Hospital Cardiac Arrest in the United States. Circulation. 2015;131(16):1415-1425. doi:10.1161/CIRCULATIONAHA.114.014542
  • Dolmatova E V., Moazzami K, Klapholz M, Kothari N, Feurdean M, Waller AH. Impact of Hospital Teaching Status on Mortality, Length of Stay and Cost Among Patients With Cardiac Arrest in the United States. Am J Cardiol. 2016;118(5):668-672. doi:10.1016/j.amjcard.2016.05.062
  • Geri G, Fahrenbruch C, Meischke H, et al. Effects of bystander CPR following out-of-hospital cardiac arrest on hospital costs and long-term survival. Resuscitation. 2017;115:129-134. doi:10.1016/j.resuscitation.2017.04.016
  • Eid SM, Abougergi MS, Albaeni A, Chandra-Strobos N. Survival, expenditure and disposition in patients following out-of-hospital cardiac arrest: 1995–2013. Resuscitation. 2017;113:13-20. doi:10.1016/j.resuscitation.2016.12.027

Through The Cords airway devices could reduce complications by 55%: preventing 167,000 major complications, saving nearly 45,000 lives and $1B in unnecessary medical costs.

“Quantifying the Complications and Impact of Persistent Intubation Problems, Runnels 2018”

  • Harris K. Endotracheal tube exchangers: should we look for safer alternatives? Heart Lung, 201;41(1):67-9
  • DeAlmeida,JP. Bronchial injury and pneumothorax after reintubation using an airway exchange catheter. Braz J Anesthesiol, 2013;63(1);107-9
  • Sheron McLean. Airway Exchange Failure and Complications with the Use of the Cook Airway Exchange Catheter®: A Single Center Cohort Study of 1177 Patients. Anesth Analg 2013;117:1325–7

Once in the trachea, an intuitive depth control system allows precise tip depth control throughout the intubation.

“Catheter Depth Control During Endotracheal Tube Exchanges in an Airway Manikin; A Comparison of a Novel Color-Zoned Qualitative System vs Traditional Quantitative System, Runnels 2018”

  • Harris K. Endotracheal tube exchangers: should we look for safer alternatives? Heart Lung, 201;41(1):67-9
  • DeAlmeida,JP. Bronchial injury and pneumothorax after reintubation using an airway exchange catheter. Braz J Anesthesiol, 2013;63(1);107-9
  • Sheron McLean. Airway Exchange Failure and Complications with the Use of the Cook Airway Exchange Catheter®: A Single Center Cohort Study of 1177 Patients. Anesth Analg 2013;117:1325–7

Each year hundreds of thousands of major complications happen in emergency intubations because of first pass intubation failures and poor depth control. These complications lead to excess deaths in critically ill patients.

“Estimating the Economic and Absolute Number of Complications Associated with Emergency Intubations Performed Outside the Operating Room; A Methodology for Estimating the Burden in the United States, Runnels 2019”

  • Mort TC. Emergency Tracheal Intubation: Complications Associated with Repeated Laryngoscopic Attempts. Anesth Analg. 2004;99(2):607-613. doi:10.1213/01.ANE.0000122825.04923.15
  • Sakles JC, Chiu S, Mosier J, Walker C, Stolz U. The importance of first pass success when performing orotracheal intubation in the emergency department. Acad Emerg Med. 2013;20(1):71-78. doi:10.1111/acem.12055.The
  • Martin LD, Mhyre JM, Shanks AM, Tremper KK, Kheterpal S. 3,423 Emergency Tracheal Intubations at a University Hospital. Anesthesiology. 2011;114(1):42-48. doi:10.1097/aln.0b013e318201c415
  • Hasegawa K, Shigemitsu K, Hagiwara Y, et al. Association Between Repeated Intubation Attempts and Adverse Events in Emergency Departments: An Analysis of a Multicenter Prospective Observational Study. Ann Emerg Med. 2012;60(6):749-754.e2. doi:10.1016/j.annemergmed.2012.04.005
  • Hasegawa K, Hagiwara Y, Imamura T, et al. Increased incidence of hypotension in elderly patients who underwent emergency airway management: An analysis of a multi-centre prospective observational study. Int J Emerg Med. 2013;6(1):1-8. doi:10.1186/1865-1380-6-12
  • Rognås L, Hansen TM, Kirkegaard H, Tønnesen E. Pre-hospital advanced airway management by experienced anaesthesiologists: A prospective descriptive study. Scand J Trauma Resusc Emerg Med. 2013;21(1):1-10. doi:10.1186/1757-7241-21-58
  • Kim J, Kim K, Kim T, et al. The clinical significance of a failed initial intubation attempt during emergency department resuscitation of out-of-hospital cardiac arrest patients. Resuscitation. 2014;85(5):623-627. doi:10.1016/j.resuscitation.2014.01.017
  • Duggan LV, K.S. M, Griesdale DE, et al. Complications increase with greater than one endotracheal intubation attempt: experience in a Canadian adult tertiary-care teaching center. J Clin Anesth. 2014;26(2):167. doi:10.1016/j.jclinane.2013.12.005
  • Chi JH, Knudson MM, Vassar MJ, et al. Prehospital hypoxia affects outcome in patients with traumatic brain injury: A prospective multicenter study. J Trauma - Inj Infect Crit Care. 2006;61(5):1134-1141. doi:10.1097/01.ta.0000196644.64653.d8
  • Spaite DW, Hu C, Bobrow BJ, et al. Association of Out-of-Hospital Hypotension Depth and Duration With Traumatic Brain Injury Mortality. Ann Emerg Med. 2017;70(4):522-530.e1. doi:10.1016/j.annemergmed.2017.03.027
  • Park L, Zeng I, Brainard A. Systematic review and meta-analysis of first-pass success rates in emergency department intubation: Creating a benchmark for emergency airway care. EMA - Emerg Med Australas. 2017;29(1):40-47. doi:10.1111/1742-6723.12704
  • Rui P, Hing E, Okeyode T. National Ambulatory Medical Care Survey : 2008 Summary Tables.; 2014. http://www.cdc.gov/nchs/ahcd/ahcd_products.htm.
  • Pfuntner A, Wier LM, Stocks C. Most Frequent Procedures Performed in U.S. Hospitals, 2011: Statistical Brief #165. Vol 2011.; 2006. https://www.hcup-us.ahrq.gov/reports/statbriefs/sb165.pdf.
  • Frost & Sullivan. U.S. Anesthesia and Respiratory Products Markets.; 2003. http://www.frost.com/prod/servlet/report-overview.pag?repid=A393-01-00-00-00.
  • Mathers CD, Ezzati M, Lopez AD. Measuring the burden of neglected tropical diseases: The global burden of disease framework. PLoS Negl Trop Dis. 2007;1(2). doi:10.1371/journal.pntd.0000114
  • Meara JG, Leather AJM, Hagander L, et al. Global Surgery 2030: Evidence and solutions for achieving health, welfare, and economic development. Lancet. 2015;386(9993):569-624. doi:10.1016/S0140-6736(15)60160-X
  • Rugulies R, Ando E, Ayuso-Mateos JL, et al. WHO/ILO work-related burden of disease and injury: Protocol for systematic reviews of exposure to long working hours and of the effect of exposure to long working hours on depression. Environ Int. 2019;125(November):515-528. doi:10.1016/j.envint.2018.11.011
  • Bernhard M, Becker TK, Gries A, Knapp J, Wenzel V. The First Shot Is Often the Best Shot. Anesth Analg. 2015;121(5):1389-1393. doi:10.1213/ane.0000000000000891
  • Lascarrou JB, Boisrame-Helms J, Bailly A, et al. Video Laryngoscopy vs Direct Laryngoscopy on Successful First-Pass Orotracheal Intubation Among ICU Patients. JAMA. 2017;317(5):483. doi:10.1001/jama.2016.20603
  • Rinderknecht AS, Dyas JR, Kerrey BT, Geis GL, Ho MH, Mittiga MR. Studying the Safety and Performance of Rapid Sequence Intubation: Data Collection Method Matters. Newgard C, ed. Acad Emerg Med. 2017;24(4):411-421. doi:10.1111/acem.13145
  • Spaite DW, Hu C, Bobrow BJ, et al. The Effect of Combined Out-of-Hospital Hypotension and Hypoxia on Mortality in Major Traumatic Brain Injury. Ann Emerg Med. 2017;69(1):62-72. doi:10.1016/j.annemergmed.2016.08.007
  • Spaite DW, Bobrow BJ, Keim SM, et al. Association of Statewide Implementation of the Prehospital Traumatic Brain Injury Treatment Guidelines With Patient Survival Following Traumatic Brain Injury. JAMA Surg. May 2019:e191152. doi:10.1001/jamasurg.2019.1152
  • Diggs LA, Yusuf J-E (Wie), De Leo G. An update on out-of-hospital airway management practices in the United States. Resuscitation. 2014;85(7):885-892. doi:10.1016/j.resuscitation.2014.02.032
  • Bernhard M, Bax SN, Hartwig T, et al. Airway Management in the Emergency Department (The OcEAN-Study) - a prospective single centre observational cohort study. Scand J Trauma Resusc Emerg Med. 2019;27(1):20. doi:10.1186/s13049-019-0599-1
  • Taboada M, Doldan P, Calvo A, et al. Comparison of Tracheal Intubation Conditions in Operating Room and Intensive Care Unit. Anesthesiology. 2018;129(2):321-328. doi:10.1097/ALN.0000000000002269
  • Casey JD, Janz DR, Russell DW, et al. Bag-Mask Ventilation during Tracheal Intubation of Critically Ill Adults. N Engl J Med. 2019;380(9):811-821. doi:10.1056/NEJMoa1812405
  • De Jong A, Rolle A, Molinari N, et al. Cardiac Arrest and Mortality Related to Intubation Procedure in Critically Ill Adult Patients. Crit Care Med. 2018;46(4):532-539. doi:10.1097/CCM.0000000000002925
  • Boyce JM, Potter-Bynoe G, Dziobek L. Nosocomial Pneumonia in Medicare Patients. Arch Intern Med. 1991;151(6):1109. doi:10.1001/archinte.1991.00400060053009
  • Siddique R, Neslusan CA, Crown WH, Crystal-Peters J, Sloan S, Farup C. A national inpatient cost estimate of percutaneous endoscopic gastrostomy (PEG)-associated aspiration pneumonia. Am J Manag Care. 2000;6(4):490-496. https://www.ajmc.com/journals/issue/2000/2000-04-vol6-n4/apr00-635p490-496.
  • Warren DK, Shukla SJ, Olsen MA, et al. Outcome and attributable cost of ventilator-associated pneumonia among intensive care unit patients in a suburban medical center*. Crit Care Med. 2003;31(5):1312-1317. doi:10.1097/01.CCM.0000063087.93157.06
  • Katzan IL, Dawson N V., Thomas CL, Votruba ME, Cebul RD. The cost of pneumonia after acute stroke. Neurology. 2007;68(22):1938-1943. doi:10.1212/01.wnl.0000263187.08969.45
  • Tong S, Amand C, Kieffer A, Kyaw MH. Trends in healthcare utilization and costs associated with acute otitis media in the United States during 2008–2014. BMC Health Serv Res. 2018;18(1):318. doi:10.1186/s12913-018-3139-1
  • Olasupo O, Xiao H, Brown J. Relative Clinical and Cost Burden of Community-Acquired Pneumonia Hospitalizations in Older Adults in the United States—A Cross-Sectional Analysis. Vaccines. 2018;6(3):59. doi:10.3390/vaccines6030059
  • Kolte D, Khera S, Aronow WS, et al. Regional Variation in the Incidence and Outcomes of In-Hospital Cardiac Arrest in the United States. Circulation. 2015;131(16):1415-1425. doi:10.1161/CIRCULATIONAHA.114.014542
  • Dolmatova E V., Moazzami K, Klapholz M, Kothari N, Feurdean M, Waller AH. Impact of Hospital Teaching Status on Mortality, Length of Stay and Cost Among Patients With Cardiac Arrest in the United States. Am J Cardiol. 2016;118(5):668-672. doi:10.1016/j.amjcard.2016.05.062
  • Geri G, Fahrenbruch C, Meischke H, et al. Effects of bystander CPR following out-of-hospital cardiac arrest on hospital costs and long-term survival. Resuscitation. 2017;115:129-134. doi:10.1016/j.resuscitation.2017.04.016
  • Eid SM, Abougergi MS, Albaeni A, Chandra-Strobos N. Survival, expenditure and disposition in patients following out-of-hospital cardiac arrest: 1995–2013. Resuscitation. 2017;113:13-20. doi:10.1016/j.resuscitation.2016.12.027

Articulating Introducer 50% Lower First Pass Failure Rate.

  • Sakles JC, Mosier JM, Chiu S, Keim SM. Tracheal Intubation in the Emergency Department: A Comparison of GlideScope® Video Laryngoscopy to Direct Laryngoscopy in 822 Intubations. The Journal of Emergency Medicine. 2012;42(4):400-405. doi:10.1016/j.jemermed.2011.05.019.
  • Aziz MF, Dillman D, Fu R, Brambrink AM. Comparative Effectiveness of the C-MAC Video Laryngoscope versus Direct Laryngoscopy in the Setting of the Predicted Difficult Airway. Anesthesiology. 2012;116(3):629-636. doi:10.1097/aln.0b013e318246ea34.