A periscope-based, 3D printed indirect laryngoscope for resource limited settings: a non-randomized observational manikin trial

In the United States and other resource-rich settings, video laryngoscopy is often favored for emergency intubation over direct laryngoscopy due to ease of use and improved performance in difficult airways. Video laryngoscopes pose a significant cost barrier against adoption in low- and middle-income countries (LMICs). In this study, we designed and tested a low-cost, 3D printable, periscope-based laryngoscope that achieves an indirect view of the vocal cords without the use of a video camera. The absence of expensive video components allows this device to be manufactured for $4.41 USD, making it well-suited for resource-limited settings. The periscope-based laryngoscope was manufactured from polylactic acid (PLA) filament using a 3D printer. Manikin testing of the laryngoscope was performed by providers ranging from medical students to experienced physicians using the high fidelity Laerdal SimMan®. The novel laryngoscope was compared to commonly available direct and video laryngoscopes, and intubation times and first-pass success rates were recorded. A total of 121 trials were performed. In experienced intubators, faster intubation times were seen in the direct and periscope-based laryngoscopes compared to video laryngoscopes. Mean intubation times for experienced intubators were as follows: Direct Laryngoscope = 17.45 s, Video Laryngoscope = 23.34 s, and Novel Periscope-based Laryngoscope = 11.31 s, with statistical significance (p < 0.001) found between the Video and Periscope-based laryngoscope times. 100% of trials resulted in successful intubation of the trachea. The periscope-based laryngoscope yielded intubation times and first-pass success rates that compare favorably to direct and video laryngoscopes, and it can be readily manufactured in multiple environments at a low price point without proprietary industrial technology. Next steps include human clinical trials and regulatory approvals prior to clinical adoption of the novel device.