A team of biomedical engineering students from Johns Hopkins University is attracting attention with its newest design, the CricSpike, which is intended to facilitate opening airways of afflicted soldiers on the battlefield.
A corpsman with Field Medical Training Battalion West learns to perform an emergency cricothyroidotomy to re-establish a functioning airway on a simulated wounded victim during the Field Medical Service Technician Course aboard Marine Corps Base Camp Pendleton, California, USA. The ‘golden hour’ is essential to saving the life of any human who is victim to trauma and this include soldiers injured in a war zone. Life-saving tactical care includes the implementation of a tool that rapidly relieves obstructed airways on and off the battlefield, such as the CriSpike (Photo by Pvt. Robert Bliss/Released)
The website is open to JHU students and presents research and prototype design of the device via an interactive interface-site. The students have teamed with Johns Hopkins Military & Veterans Health Institute to create a kit to support deployed medical professionals in their efforts to resuscitate soldiers afflicted with airway obstruction.
Maxillofacial Injury is most common with domestic violence, motor vehicle crashes, sports injuries, and in combat. Facial nerves, blood supply, tissue, bone and nasal passages can all be affected by harm to the upper, mid and lower face. Basic X-Ray and CT scans can be used to analyse severity of maxillofacial injury. The impetus behind the CricSpike is to streamline the cricothyrotomy procedure so that it can be performed in an expeditious manner in a war zone, where time is often a luxury. In order for the students design the most efficient field ready device they needed to understand the critical pathophysiology behind airway obstruction and maxillofacial trauma.
The JHU team’s website discusses the severity of tactical field care and how medical professionals during high stress situations often do not have the time or equipment to perform the procedures needed to save or sustain life while a higher level of care is being coordinated. Maxillofacial and craniomaxillofacial injury ranges from 26-42 per cent of wounds experienced in military combat situations; maxillofacial injury is one of three most prominent causes of airway trauma, behind neurological injury, and fractures and wounds to the airway. Failure rate to perform the necessary procedures on the battlefield is 33%. These field procedures are often significantly more complicated as compared to a regular clinical setting in the civilian sector.
Some variables contributing to the complexity includes the patients’ severity of injury, lack of mobile supplies, a variety of environmental war zone dangers and location of where the procedure is being performed. When in a combat zone and a soldier sustains an injury that causes airway obstruction, intervention is emergent and therefore may need to be performed within the hot zone; this puts medical personnel in harm’s way and may affect the time it takes to care for the injured soldier.
Johns Hopkins’ prototype, the CricSpike, is a kit that aims to reduce time needed to perform battlefield cricothyrotomy. The kit includes an intra-tracheal tip, a removable handle, scalpel, BMV, and a securing piece.
The students conducted a full literature search, analysed current kits and pinpointed issues that allowed for margins of error. This kit, with designs including blunt tips for tracheal puncture prevention, also contains a break-apart handle with a supporting tracheal piece to be inserted to stabilise a breathing tube. A right angle curve on the exit port of the tracheal piece allows for a tube that can be manipulated for air passage into the trachea.
Diagram of the CrikSpike Handheld Emergency Cricothyrotomy Assist Device (Johns Hopkins BME Department)
The break-apart handle makes it easy to insert the device into the stoma, stabilising the inner piece to allow for breathing tubes into the trachea. Low degrees of freedom, large pieces suitable for medic-grip, labeling for correct placement, and fins to dilate the tracheal opening all are design characteristics that are either new or more advanced from what is currently on the market.
While the prototype is still in early phases of design, the students have proved their research and design is essential to the future of battlefield medicine and saving the lives of soldiers. They were recently awarded second place at the Innovation Research Lab Exhibition, and third place at Johns Hopkins’ Student Health Care Design Competition.
A video of the team presenting at Johns Hopkins’ 2016 Design Day includes a demonstration of how easy the device is to use; it also shows that after two small incisions with a scalpel the device can be inserted and ventilation can begin in less than a minute. Ventilation is demonstrated by way of an educational manikin after the breathing tube has been placed. “…[It] directly prevents the breathing tube from entering the subcutaneous tissue…” says Antonio Spina, team leader of CricSpike.
The CricSpike kit is at the forefront of innovation for providing life saving interventions for soldiers on the battlefield. The ‘golden hour’ is essential to saving the life of any human who is victim to trauma and this include soldiers injured in a war zone. Life saving tactical care includes the implementation of a tool that rapidly relieves obstructed airways on and off the battlefield.
The video can be watched here.