Advice

Summary

Summary

  • The technology described in this briefing is Ambu aScope 4 Broncho. It is intended for use in routine diagnostic and therapeutic bronchoscopy procedures. NICE has produced medical technologies guidance on Ambu aScope4 Broncho for use in unexpected difficult airways.

  • The innovative aspects are that the single-use bronchoscope potentially reduces the risk of cross-infection and eliminates the need for complex reprocessing of reusable endoscopes.

  • The intended place in therapy would be wherever a flexible fibre-optic endoscope is needed for routine diagnostic and therapeutic bronchoscopy procedures. This device can be used for adults in hospital settings, including in theatre, in the emergency department and in critical care.

  • The main points from the evidence summarised in this briefing are from 4 studies (2 prospective observational studies, 1 retrospective observational study and 1 cross-sectional study) including a total of 551 patients. The studies suggest that some clinicians accept, are generally satisfied with, and sometimes prefer Ambu aScope 4 Broncho when used in routine diagnostic and therapeutic bronchoscopy. Low video image quality was reported but it is not clear if this quality is lower than with reusable bronchoscopes. Loss of functionality during the procedure, and failure to reach some lung segments in a few cases, have also been reported.

  • The key uncertainty around the evidence or technology is that the studies mainly focus on user experience and satisfaction and there is limited published evidence reporting relevant clinical outcomes to support routine use of the technology for endoscopic procedures and airway examination. Also, most studies were done outside the UK and sample sizes were mostly too small to generalise the findings.

  • Experts advised that the technology is not a major innovation, but can simplify access to bronchoscopes, especially in urgent cases.

  • Safety issues identified are the same as those with reusable endoscopes. Some experts noted problems with the quality of the display images.

  • The cost of Ambu aScope 4 Broncho plus the Ambu aScope 4 BronchoSampler (Broncho Sampler Set) is £185 per unit and £925 for a box of 5 (excluding VAT). The aView 2 Advance display monitor is an additional £4,000.