Learning curve: developing the video laryngoscope

How a university design project blossomed into a medical product - a video laryngoscope - that's taken the market by storm.

Running time: 5 min 53 s.
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"This is not the most attractive brief, but it should be a challenging one." The opening words to Matt McGrath's workbook for the 'Smartscope' laryngoscope, designed for the 1999 Royal Society of Arts Student Design Awards, hint at his determination and willingness to take on something different. The 'Medical Products' brief he mentioned boasted "a rare chance for a product designer to revitalise the use of a traditional device". And that's exactly what the Northumberland University undergraduate did.

Under ten years on, Mr McGrath is now CEO of Aircraft Medical, an Edinburgh-based company that has signed distribution deals thought to be worth nearly £60m in sales over the next five years. The 'Smartscope', which went on to win the design award, has undergone several incarnations to become the McGrath Series 5 video laryngoscope, a compact, innovative piece of medical kit that now finds itself in the coat pockets of many anaesthetists and critical care physicians.

While the laryngoscope may not have been the most glamorous candidate for a redesign, it was a worthy one. The device is used widely in the medical world as it allows doctors to get a clear view of the larynx (voicebox). This is important for intubation, the process where a tube is inserted into a patient's windpipe to keep the airway open, either during an operation or in an emergency.

The design of the Macintosh - one of two main types of laryngoscope currently in use - has not changed significantly since the 1940s. The shape of this instrument means that doctors cannot see 'around the corner' into the larynx when using the instrument, and so must take great care not to damage the soft tissue of the throat or the teeth.

The McGrath Series 5 laryngoscope was designed to try and improve on conventional instruments in a number of ways, from making it easier for medical staff to get a good view of the larynx, to the inclusion of a guaranteed sterile blade. Powered by a single AA battery and with a built-in light and camera with no trailing cables, the McGrath device is the first truly portable video laryngoscope. The colour LCD screen mounted on the handle gives doctors a clear view down the airway, helping them to place the tube with a lower risk of damaging the teeth or other tissue.

With traditional laryngoscopes different sized blades would be attached to the handle, according to the particular patient's size and anatomy. The McGrath laryngoscope is the first to have a variable length blade, allowing medical staff to choose from three different lengths. A disposable, single-use blade prevents cross-contamination between patients.

Matt McGrath is not a medic, nor was he particularly interested in medical devices - he won an Royal Society of Arts design award in 1998 after designing a new kind of telecommunications mast - but the laryngoscope project was appealing to him. He sees his lack of experience in this sector as an advantage, "My background was design, not medical, and I think that’s led to a pretty good outcome in this project," he says.

According to him, the key to creating an effective and appealing product is to engage with as many different people as possible. "We have engaged with thousands of medical practitioners in our research ranging from novices to experts, but we are also, for example, engaged with those who clean the equipment, fix it, deliver it, and so on, and we have learned a great deal by taking this approach" Mr McGrath says.

The idea for an adjustable blade came from just such a conversation. "I was speaking to a paramedic outside A and E. When he opened his motorbike carry case, all this stuff burst out, including a load of laryngoscope blades," Mr McGrath says. "That's where the idea of a variable length blade that could fit all patients came from."

In all, Mr McGrath and colleagues spoke to some 1500 end-users in the development of the laryngoscope. "When the product was launched it was really well market-tested; it was really designed by the market," he says. Published data suggest that the McGrath laryngoscope is an "effective aid to airway management" in patients with normal airways1, and is also useful for patients in which intubation is difficult or has failed2.

But how did the rough pencil sketches in a design undergraduate's workbook become a multi-million pound medical device? After winning the Royal Society of Arts award in the final year of his degree, Mr McGrath was funded by the Audi Design Foundation to develop a prototype.

He founded Aircraft Medical in 2001 and the company subsequently received awards from the Prince's Trust, the Scottish Executive and Scottish Enterprise. The Wellcome Trust awarded the company a £300 000 University Translation Award in 2004, an award designed to bridge the funding gap in the commercialisation of new technologies. The Trust provided support at the design stage and in 'reducing to practice' - essentially proving that your invention works as you say it does - as well as funding regulatory approval.

Asked if he regrets anything, Mr McGrath says that it's that he didn't approach the Trust earlier for support. "the video laryngoscope was a groundbreaking idea, but like any groundbreaking idea the market for it did not really exist yet, so the traditional measures for risk that investors would normally look at."

The investment certainly seems to have paid off. In August 2006, Aircraft Medical Ltd signed a £27-million distribution deal with LMA North America, a leading brand in airway management. Aircraft Medical now has distributors in 19 countries, across North America, Europe and Australasia. 

Mr McGrath says that doctors often buy the video laryngoscopes (which cost around £4,500) with their own money, just so they can have one on them. In the first months of production some teething problems with the technology meant that some doctors had to return their initial models. Such is the appeal of the device that many refused to part with them even for a day or so. Supported by further Trust funding, the company is now developing a sophisticated new product for use in infants and children, which is planned for launch in 2010.

As well as planning to expand the Series 5's market in Europe, Mr McGrath’s company has scope for new products. "We’ve got good infrastructure - we design the product, assemble it and ship it into distribution, and we’re capable of doing that with other products," he says. "We’ve made a good start with the laryngoscope, and there are hundreds of devices and technologies that anaesthetists use day in, day out that would appeal to us."

References

Shippey B et al. Case series: the McGrath videolaryngoscope - an initial clinical evaluation. Can J Anaesth 2007;54(4):307-13.

Shippey B et al. Use of the McGrath videolaryngoscope in the management of difficult and failed tracheal intubation. Br J Anaesth 2008;100(1):116-9.

Awards made to Matt McGrath and Aircraft Medical

2008 - Young Scot of the Year (The Institute of Contemporary Scotland)
2007 - National Award for Medical Innovation (Medilink UK)
2006 - Emerging Entrepreneur of the Year (Entrepreneurial Exchange)
2006 - Prince's Trust Award in Recognition of Business Innovation
2001 - Young Innovator of the Year (Scottish Enterprise)
1999 - Royal Society of Arts Design Directions (Medical Products Category)
1998 - Royal Society of Arts Design Directions (Communications Category)