Photo By Paul Lagasse | This drawing illustrates an expandable airway tube invented by Dr. Corinne Nawn and...... read more read more
FORT DETRICK, Md. – The Medical Research and Development Command’s Office of Medical Technology Transfer is looking for entrepreneurs to help them fast-track a suite of innovative new tools that reduce risks to patients and surgeons during complex airway surgical procedures.
According to the Joint Trauma System Clinical Practice Guideline for Airway Management in Prolonged Field Care, compromised and obstructed airways represent the second most frequent cause of potentially survivable death on the battlefield after blood loss. A Warfighter with a severe airway obstruction is at risk of death from suffocation within minutes. That’s why management of traumatic airway injuries is critically important for medical providers who work with combat casualties. However, many medics lack extensive training in the skills necessary for conducting airway procedures. To help fill that crucial gap, the MTT is working with military surgeons to develop and de-risk medical devices they have invented to the point where they are ready to be licensed by small businesses.
“It is extremely important for us to create, develop and find inventions that help surgeons improve surgical treatment for Service Members who sustain airway injuries,” says Dr. Paul Michaels, MTT’s director. “Blood loss and airway injuries are the two most common injuries facing combat surgeons in high-intensity combat situations. Many of the projects we are now working on with our licensees and collaborators will help improve the survivability of those who sustain airway injuries.”
Using Light to Position an Endotracheal Tube
Endotracheal intubation, or the insertion of a breathing tube through a patient’s mouth or nose into their windpipe – called the trachea – is a common surgical intervention on the battlefield. However, it can be challenging to insert the tube correctly the first time – even for a skilled practitioner in a hospital setting – and repeated removal and reinsertion risks causing further injury. A reliable way of determining accurate tube placement could therefore save precious time and potentially save a patient’s life.
To address this challenge, Dr. Corinne Nawn and Dr. Brian Souhan invented a method of detection that uses the scientific principle that different materials – and different thicknesses of the same material – absorb and reflect light differently. Fitting an endotracheal tube with a pinpoint light emitter and a photosensitive element, they reasoned, would enable a care provider to identify the correct location by comparing the absorption patterns of the reflected light with the known absorption patterns of the tissues in various parts of the trachea. When the patterns match, a green light appears on the device’s display. If it becomes misaligned, the light changes to red.
Nawn, who at the time was studying for her Ph.D. in biomedical engineering while supporting projects for the U.S. Army Institute of Surgical Research at Joint Base San Antonio Texas, and Souhan, who was an instructor at the United States Military Academy in West Point, New York, collaborated via email and site trips over the course of several years to develop an accurate reflectivity “map” of the human trachea.
“The testing was an iterative process that involved placing tracheal and esophageal tissue samples in a hyperspectral camera system and testing them at multiple angles and in multiple conditions to identify their key characteristics,” explains Souhan. “It required us to apply a broad spectrum of skills, and it was a very satisfying experience.”
Nawn said that the device, once fully developed, would be useful in a wide range of trauma care scenarios, not just on the battlefield.
“In ICUs and emergency departments, the nurse-to-patient ratio is steadily increasing, so you need technology to fill the gap that used to be met by human attention,” says Nawn, “This technology promises to reduce a care provider’s cognitive burden and provide an additional safety check in chaotic situations where the endotracheal tube is at risk of becoming dislodged, such as during transport in the back of an ambulance or in a MEDEVAC helicopter.”
Nawn’s and Souhan’s intubation guidance technology would likely not have been possible without the extensive networks of professional relationships that MRDC’s researchers and engineers cultivate to maximize the impact of their game-changing ideas. They were introduced to each other by Col. Robert Carter, who was at the time the director of USAISR’s Pre-Hospital Combat Casualty Care Research Program. Carter had worked with Souhan in Afghanistan, where they both served on a Field Assistance in Science and Technology team with Combined Joint Task Force Paladin. Souhan even co-authored a scientific paper with Carter before going off to get his Ph.D. in electrical and electronic engineering with an emphasis on photonics. Tasked with forming a program to develop emergency airway management devices that are easier for inexperienced medics to use, Carter suggested that Nawn team up with Souhan to see if photonics could provide a solution.
“I said, ‘Here’s a problem that I think would be really interesting to solve,’” recalls Carter, now MRDC’s chief of staff. “They both had expertise in photonics, so it made sense to introduce them. And we ended up publishing a paper on it, too!”
Protecting Windpipes with an Expandable Airway Tube
When injuries to the face or airway prevent intubation through the mouth or nose, or when a patient will be connected to a ventilator for a long period, doctors perform a procedure called a tracheotomy. This involves making a hole in the front of the patient’s neck into the trachea and inserting a breathing tube through the hole. Tracheotomies are a common procedure; over 100,000 are performed every year in the United States – but they, too, can present challenges for medical practitioners. In particular, breathing tubes must be regularly removed and replaced with narrower ones to allow patients to recover their ability to speak and swallow. However, it can be challenging and stressful for a doctor to thread a new tube through the thick neck muscle tissue. Sometimes the tube can miss the airway altogether, causing a dangerous obstruction.
To solve this problem, Maj. Joshua Stramiello, an otolaryngologist and the chief of surgery with the 48th Medical Group at RAF Lakenheath, UK, invented a two-piece tracheotomy tube that greatly simplifies the process of swapping out different tube sizes. It consists of an expandable outer tube that remains in place for as long as it’s needed and acts as a guide for a rigid, removable inner tube that is available in various diameters. By leaving the outer tube in place as a reliable guide, Stramiello’s design makes the tube replacement process much simpler, faster – and safer.
“I don't think I'm the first person to think of this idea, but there's nothing else out there like it,” says Stramiello, who designed and developed the prototype over the course of many evenings using his own computer models and 3D printer. “When I initially thought about how to solve the problem, I realized it was a very complex issue. But when it comes to surgery, simpler is always better.”
Through a colleague, Stramiello was introduced to Beth Drees, the intellectual property and licensing manager for the DHA’s San Antonio market, who worked with him to submit his design to the DHA innovation committee. The committee invited Stramiello to present his invention to the committee, where it received positive feedback. This encouraged him to apply for a patent.
“My invention has the potential for a wide range of applications beyond airway management following a traumatic injury,” says Stramiello. “It's also something that could be used in the civilian world for cancer surgery or other airway abnormalities. It's really rewarding to develop something that not only could improve military medicine, but medicine in general.”
Putting Innovative Tools in Surgeons’ Hands
The Office of Medical Technology Transfer works with inventors, businesses and investors to commercialize and deliver innovative life-saving devices and medicines for the Warfighter and the public. MTT uses an award-winning process for systematically maturing and de-risking first-generation biomedical technologies called Assistive Technology Transfer, or AT2. More than 30 biomedical technologies have been successfully licensed using AT2, generating over $26 million in royalty income that MTT has used to reward inventors and invest back into the AT2 program to help move other new inventions through the development cycle – creating what MTT calls a feedback loop of success.
“These examples illustrate how clinicians and surgeons, who deal with patients every day, are ideally positioned to identify capability gaps in airway management,” says Drees. “The solutions they design to address these gaps are often relatively simple and inexpensive to manufacture, while significantly improving patient care.”
This is Part 1 of a two-part series.
The intellectual property discussed in this story:
• Airway Management Device for Identification of Tracheal and/or Esophageal Tissue, U.S. Patent 10,980,955
• Expandable Tracheostomy Tube, U.S. Provisional Patent Application 63/704,784
To inquire about applying for a license on any of the technologies discussed in this story, visit https://technologytransfer.health.mil or contact the MTT at (301) 619-0033 or USArmy.Detrick.MEDCOM-USAMRMC.List.ORTA@health.mil.
| Date Taken: | 03.25.2025 |
| Date Posted: | 03.25.2025 14:18 |
| Story ID: | 493707 |
| Location: | FORT DETRICK, MARYLAND, US |
| Web Views: | 78 |
| Downloads: | 1 |
This work, MRDC Seeks Entrepreneurs to License Innovative Airway Surgical Devices (Part 1), by Paul Lagasse, identified by DVIDS, must comply with the restrictions shown on https://www.dvidshub.net/about/copyright.
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