NICE opens consultation on endoscopic device for intubation

22-Mar-2013

Research suggests Ambu aScope2 can save money and improve intubation in complex patients

A drive by the NHS to encourage more widespread adoption of innovative medical devices continues this week with the launch of a consultation into equipment designed to help health professionals experiencing intubation difficulties.

The National Institute of Health and Clinical Excellence (NICE) has opened a consultation on its draft medical technology guidance covering the Ambu aScope2, a thin, single-use, flexible endoscope with accompanying monitor that uses video camera technology to help health professionals see the windpipe more clearly, so that breathing tubes can be correctly placed when intubating patients with difficult airways.

The draft guidance supports the case for adopting the Ambu aScope2 for use in people with unexpected difficult airways needing emergency intubation. The evidence considered indicates that the aScope2, manufactured by Ambu, is an acceptable alternative when a multiple-use fibre optic endoscope is unavailable. The multiple-use endoscope is the current gold standard device used for managing difficult intubation.

There are an estimated 22,000 instances each year in the UK where there are unexpected difficulties with endotracheal intubation in patients

An example of a procedure where endotracheal intubation may be needed is when a general anaesthetic is given. There could be unexpected difficulties when intubating any patient. Conditions which increase the risk include where a patient is obese, has limited mouth opening or cervical spine movements, has experienced trauma to the face or neck, has respiratory tract infections or cancers. The Ambu aScope2 may also be used to replace dislodged tracheostomies, a surgical procedure where an opening has been created through the neck at the front of the windpipe and a tube connected to an oxygen supply inserted to help with breathing.

The Ambu aScope2 system is a portable device consisting of two components: a single use aScope (endoscope) and an accompanying aScope monitor for displaying the images. The manufacturer claims benefits of using the device include improved outcomes in emergencies and unexpected scenarios of difficult airway management due to the immediate availability of a sterile fibre optic endoscope that does not need calibration; a reduced risk of cross-infection from contaminated multiple-use fibre optic endoscopes; and improved safety for patients with tracheostomies.

The evidence suggests that using the Ambu aScope2 is supported by cost models for a range of clinical settings where there is no access to a multiple-use endoscope or one is unavailable. Those settings are isolated units, operating theatre units, and intensive care units. The amount of money saved will depend on the number of intubations performed and on the number, if any, of existing multiple-use fibre optic endoscopes in use. As an example, the economic models indicate that savings could be highest when using the Ambu aScope2 in the intensive care setting, with estimated savings of around £3,000 per unit each year in specific circumstances.

The evidence considered indicates that the Ambu aScope2 is an acceptable alternative where a multiple-use fibre optic endoscope is unavailable

Professor Carole Longson, director of the NICE Centre for Health Technology Evaluation, said: “There are an estimated 22,000 instances each year in the UK where there are unexpected difficulties with endotracheal intubation in patients.

“The independent Medical Technologies Advisory Committee (MTAC) considered that there was evidence to support the use of the Ambu aScope2 in people with unexpected difficult airways needing emergency intubation. The evidence considered indicates that the Ambu aScope2 is an acceptable alternative where a multiple-use fibre optic endoscope is unavailable.

“As well as noting advantages during replacement of dislodged tracheostomy tubes in the intensive care setting, the committee’s further preliminary recommendation is that making the Ambu aScope2 available for use across certain clinical settings is likely to improve outcomes and improve patient safety. The committee also accepted that, based on cost modelling, the device is likely to save costs across a range of clinical settings and circumstances.

“We are keen to receive comments on the draft guidance from healthcare professionals and patient groups as part of this consultation.”

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