Israel’s seeing-eye endotracheal tube

EtView’s technology enables the practitioner to accurately insert the tube into the upper respiratory tract and insure safe airway management in emergency medicine, anesthesia, and resuscitation. Any regular viewer of the hit television series ER knows what intubation is. Performed …

EtView’s technology enables the practitioner to accurately insert the tube into the upper respiratory tract and insure safe airway management in emergency medicine, anesthesia, and resuscitation. Any regular viewer of the hit television series ER knows what intubation is.

Performed almost eight million times a year in the US, intubation takes place when a person is unable to continue breathing on his own and doctors or emergency workers need to insert a tube into their upper respiratory system to clear the airwaves.

Half of the time, the patient is in the hospital, but emergency intubations also occur at the scenes of accidents, or in homes or the workplace when medical crises occur.

On ER, the new interns are always closely supervised by a senior doctor when they first intubate, and for good reason. Incorrectly inserting a tube during the procedure can result in death or brain damage. In the, a 3%-5% failure rate exists, and when intubations have to be performed in emergency conditions in a home or another location outside the hospital, the failure rate reaches 25% on the first attempt with the tube often being inserted into the esophagus instead of the trachea.

A young Israeli startup called ETView has developed an endotracheal tube called the ETT that takes the guesswork out of intubation with a tiny video camera embedded in one end of the tube. The camera enables the practitioner to accurately insert the tube into the upper respiratory tract and insure safe airway management in emergency medicine, anesthesia, and resuscitation.

“Inserting an endotracheal tube is common but it’s not easy. In many cases, the tube is either not inserted properly and goes to the esophagus or there’s a difficult prolonged intubation process, taking more than 30 seconds to insert,” CEO Ofer Friedman told ISRAEL21c. “The idea is to insert tube into the trachea in between the vocal chords. The problem is, you can’t see the vocal cords from the outside.”

ETView’s ETT with built-in sensors allows viewing the upper airways and trachea during intubation via a portable screen or monitor and permits effective ventilation during the entire process. In addition, the product allows for continuous monitoring of patients by adding a positioning indicator to existing bedside monitors.

According to Friedman, ETView’s product will provide continuous monitoring of the ETT position in the patient during transport to hospitals.

“We have a monitor, which will soon be integrated into any monitor that exists near a patient. This means that if the procedure is done outside of an emergency room, the monitor can be a cellular phone or a PDA,” said Friedman.

He added that once a patient is brought to the emergency room, the mobile monitoring device will be disconnected and the tube will be hooked up to the ordinary monitoring equipment.


According to ETView’s chief Medical Officer Noam Gavriely , this is the first time that an endotracheal tube has been developed that enables ongoing, visual monitoring of the inside of the upper respiratory tract during either resuscitation or ongoing care of an intensive care patient.

“Often a patient in an emergency unit is moved many times from station to treatment station. Each time the patient is transferred or moved there is a risk that the tube will be dislodged, which could of course endanger the patient?s life. Our product enables a 100% success rate on the first try, owing to the video camera embedded in the end of the tube and the screen showing the doctor, nurse, or paramedic precisely where the tube is. This means that there is no chance that the tube can enter the esophagus, which does occur today; you can see on the screen that you’re going into the respiratory tract,” he said.

ETView was founded by Gavriely, a professor of lung physiology at the Technion-Israel Institute of Science, at the beginning of 2004 and operating at the Misgav Technology Center in the Teradion Industrial Zone in the Galilee. Gavriely’s son Oren, a Technion student, invented the device after hearing a story from his father.

“I was working in an emergency room at a hospital in Illinois two and a half years ago – and a patient arrived with an endotracheal tube in her esophagus. When I related the story to Oren – who is an entrepreneur with experience on medical devices for companies – he proposed installing a camera at the tip of the tube,” Gavriely told ISRAEL21c.

The training version of the ETT is now in use for intubation training for doctors, paramedics, and medics at Sheba Hospital’s Center for Medical Simulation (CMS), and following receipt of FDA approval, anticipated in late 2005, will go into clinical use.

“We’ve tested the device quite extensively on a variety of mannequins in training sessions with great results,” said Friedman. “We hope to begin trials on humans within the next two months.”

Friedman and Gavriely said that their tube will improve the quality of care of the patient being respirated and reduces the cost of care and the need for multiple X-rays, as is done now in order to ascertain that the tube is in place in the respiratory tract.

“This ETT will be a huge cost saver. Today at ICU’s (intensive care units) they’re usually doing one or two X-rays to verify the position of the tube. Our camera makes that obsolete, which saves money, and frees the patient of that radiation,” said Friedman.

According to Friedman, there are two widely used solutions to complicated intubations: bronchoscopes and laryngeal masks. But using bronchoscopes is very complicated and requires specialized, expensive equipment. And Laryngeal masks are quickly inserted but often difficult to secure during transport.

“There have been other instruments that have tried some form of visualization to help intubation, but none of the have really succeed, and they’ve all been based on additions to the tube. In our case, it’s part of the tube. There’s nothing else like this – a video camera in the tube,” he said.

Gavriely is confident that once medical professionals have had the experience of using ETView’s ETT endotracheal camera tube, there will be no turning back.

“We are looking at the U.S. market as a major customer,” he said. “We also are looking at companies in the field of artificial ventilation as potential marketing partners.”