P083: USE OF HANDHELD VIDEO LARYNGOSCOPY TO IMPROVE MRI PATIENT SAFETY
Taylor L Carto; Michael Fabbro, DO
University of Miami Miller School of Medicine
Background: Video laryngoscopy (VL) has improved airway management by enhancing glottic visualization and increasing first-pass success rates. However, traditional VL systems typically consist of a screen, cord, and handheld laryngoscope blade mounted on a wheeled cart or pole (Figure 1). This design presents safety risks in the magnetic resonance imaging (MRI) suite, where ferromagnetic objects can become hazardous projectiles if introduced into the scanner’s magnetic field. In a critical incident at the University of Miami, a VL device was emergently used in the MRI suite and became entrained into the MRI machine due to its metallic components. This resulted in two major consequences: (1) the cost of shutting down the MRI machine, which can exceed $50,000 for re-energizing the magnet, along with potential downtime of one to two months, and (2) the significant safety hazard posed to patients and providers. Additionally, in Florida, entrapment incidents in MRI environments fall under state-reportable adverse events, requiring mandatory reporting to the Department of Health within 15 days.
Challenges and Solutions: The risks associated with traditional VL setups in MRI environments highlight the need for safer airway management solutions. Handheld video laryngoscopes (Figure 2), initially developed during the COVID-19 pandemic for their single-use design and reduced contamination risk, offer a promising alternative. Unlike traditional VL systems, handheld devices are compact, self-contained, and do not require a large monitor or cart, making them more suitable for the MRI suite. However, some handheld devices contain magnetic components, necessitating careful evaluation of their MRI compatibility.
Hospitals employ MRI safety representatives to assess new devices before their introduction into MRI environments. These representatives evaluate medical equipment for ferromagnetic properties and ensure only MRI-safe devices are used. Additionally, MRI environments are divided into four safety zones, with Zone IV being the high-risk area where the scanner’s magnetic field is always active. Proper assessment and labeling of medical devices before their introduction into Zone IV can prevent hazardous incidents like the entrapment of VL equipment.
Discussion: Although handheld video laryngoscopes are not explicitly labeled for MRI use by their manufacturers, certain models without ferromagnetic components may be safe for use in this setting. Their compact design eliminates the need for carts or poles, reducing the risk of entrapment. Additionally, their portability allows for deployment during MRI procedures requiring airway management without the logistical barriers posed by traditional VL systems. However, thorough MRI safety testing and verification are essential before incorporating any handheld VL device into MRI airway management protocols.
Conclusion: The adoption of MRI-compatible handheld video laryngoscopy represents a significant advancement in MRI patient safety. By eliminating large, metallic components and implementing properly vetted handheld devices, hospitals can improve patient care and provider safety while mitigating the financial and operational risks associated with MRI shutdowns. Moving forward, increased collaboration between anesthesiologists, MRI safety officers, and medical device manufacturers is necessary to develop and standardize MRI-safe airway management solutions, ensuring both efficiency and safety in MRI environments.
Figure 1
Figure 2