User-centric design and validation of a haptic interface for endotracheal intubation

Abstract

We propose a user-centric approach to developing high-fidelity haptic environments and demonstrate this process with training endotracheal intubation (ETI). We began by understanding the medical procedure and simulator requirements. This was accomplished by in-depth literature review, meeting with experts, direct observation, and biomechanics measurements. Our first outcome was a technical assessment tool for grading the performance of the ETI procedure. The significance of this research was that it provided us a quantitative way to measure the learning of trainees as they used the developed simulator. We then identified the simulator requirements to provide the highest impacting modalities that will influence training. Based on the user requirements and biomechanics of the ETI procedure, we developed a haptic mechanism – a 5-Parallelogram Lightweight Robot (5-PLR). The 5-PLR was tested to ensure that it would be able to provide the forces required by the ETI procedure. The 5-PLR was used in conjunction with another haptic device, an instrumented mannequin, to develop a virtual reality simulator for ETI. User studies indicate the ability of the simulator to distinguish between novices and experts. Randomized controlled studies have been performed to demonstrate the effectiveness of the simulator as a haptic training tool, enabling retention of the learned skills and the ability to perform ETI procedures on human patients.

Endotracheal Intubation (ETI) is a dexterous medical airway procedure that can grow increasingly difficult based on patient characteristics and unanticipated difficulties. Failing to establish an airway and provide oxygenation to a patient may lead to life-threatening complications or even death. It is most commonly learned on static mannequins or in the clinical setting with live patients. There are many patient factors, such as weight, height, and anatomy, that are not adequately simulated using these existing means.

High-fidelity haptic simulators have played a crucial role in medicine, from understanding procedures, medical examinations and intervention, to training and evaluating skills. High-fidelity training has been shown to help retain complex procedural skills and correlate psychomotor performance in virtual reality (VR) with technical skills in the operating room (OR).

In summary, we present a paradigm of developing user-centric haptic interfaces based on field testing and rigorous clinical validation with an application to endotracheal intubation.