New soft robotic device achieves 96% success rate in emergency intubation with minimal training
A novel soft robotic device has enabled emergency medical personnel to achieve intubation success rates as high as 96% with only five minutes of training, according to new research published in Science Translational Medicine. The vine-like device could dramatically expand access to life-saving airway management in emergency situations and resource-limited settings.
Subfigure of the device in various states with annotations. © David Haggerty, Marvin Wayne, and James Cazzoli
Intubation is a critical procedure used routinely during surgeries and in patients with respiratory failure or airway obstructions. However, current techniques require extensive anatomical knowledge and skilled practitioners, making successful intubation challenging outside hospital settings. Currently, intubation requires trained clinicians who have the skill and anatomical knowledge to manually guide a breathing tube through the airway.
Device enables autonomous airway navigation
The Soft Robotic Intubation System (SRIS), developed by researchers at the University of California Santa Barbara and collaborating institutions, operates on the principle of “tip extension” – a mechanism found in nature where growth occurs from the tip rather than being pushed from the base.
The device is based on the principle of tip extension, which employs a tube that extends from the tip rather than being pushed from the base. This allows the tube to conform to the airway pathway, enabling it to autonomously navigate the trachea while exerting less force on delicate tissues.
The system comprises two components: an introducer that positions the device correctly, and a self-guided tube containing a soft endotracheal tube within an inflatable overtube. As the soft tube advances, the overtube everts from its tip, pulling the breathing tube forward into the trachea.
Significant performance improvements demonstrated
Testing with expert users showed exceptional results. Using the device, experts with experience in intubation achieved success rates of 100% while intubating mannequins and cadavers in under nine seconds.
More importantly, the device showed promise when tested by less experienced personnel. Eight emergency medical services providers, including four paramedics and four emergency medical technicians, tested the device in cadavers after minimal training.
These personnel with less intubation experience achieved a success rate of 87% during first intubation attempts and required only 21 seconds, surpassing their performance during standard intubation with guided video laryngoscopy.
The preliminary study revealed significant advantages over video laryngoscopy. The authors reported: “When using the device, users achieved an 87% first-pass success rate and a 96% overall success rate, requiring an average of 1.1 attempts and 21 seconds for successful intubation, significantly (P = 0.008) faster than with video laryngoscopy.”
Reduced tissue trauma and improved tolerance
Laboratory testing demonstrated that the soft robotic device applied significantly less force to tissues during insertion. Force measurements showed the self-guided tube exerted an average of 1.5 N compared to 10.3 N for traditional endotracheal tubes – a reduction of approximately 85%.
The device also showed greater tolerance to misalignment, succeeding across a range of approximately 9 cm compared to 2.5 cm for traditional tubes. This enhanced tolerance could prove crucial in emergency situations where optimal positioning may be challenging.
Addressing critical healthcare gaps
Current intubation failure rates present significant challenges in emergency medicine. Emergency intubation has higher first-pass failure rates of ~35% in the prehospital setting and 15 to 20% in the emergency department compared with 3 to 15% in the operating room.
The research team noted: “The delayed oxygenation and increased trauma associated with repeated intubation attempts and failure in the critically ill are associated with increased severe adverse events ranging from hypoxia to cardiac arrest, which are in turn associated with increased mortality.”
Future clinical applications
The device could have particular value in challenging environments. This difficulty raises the failure rate for prehospital medical personnel, leading to life-threatening delays and complications from repeated intubation attempts.
The authors suggest the technology could benefit military medical care, where poor airway control represents the second most common preventable cause of death. Additionally, in resource-limited regions where half the world’s population lacks access to essential health services, a simple-to-use, electronics-free intubation device could help increase successful airway management in regions without access to highly trained medical personnel.
Study limitations and next steps
The researchers acknowledge several limitations, including testing in fresh cadavers rather than living patients and conducting trials in controlled environments rather than emergency situations.
Despite these limitations, the team concluded: “Such performance in a mechanical system with minimal training requirements, if validated in a powered clinical trial, could represent a promising step forward in emergency airway management capabilities.”
Reference
Haggerty, D. A., Cazzoli, J. R., Wayne, M. A., et. al (2025). A soft robotic device for rapid and self-guided intubation. Science Translational Medicine, 17(764), eads7681. https://doi.org/10.1126/scitranslmed.ads7681
