A review of environmental and economic aspects of medical devices, illustrated with a comparative study of double-lumen tubes used for one-lung ventilation

When health care management considers implementing a new technology such as a medical device, it is crucial to take workflow, clinical outcome, economy, and environmental impacts into consideration in the decision-making process. This study outlines the knowledge status of this complex challenge via a systematic literature review (SLR). The SLR found 133 of 1570 screened publications that covered relevant frameworks for choosing hospital equipment (i.e., related economics, life cycle assessment, waste generation and health issues). Yet, just five publications addressed choosing single-use vs. reuse of tubes or similar types of equipment by economic and environmental considerations through a systematic quantitative approach. The SLR reveals few publicly available peer-reviewed studies for the optimal sustainable choice of equipment. This study assesses environmental impacts of carbon dioxide (CO 2 ) emissions as CO 2 -equivalents and resource consumption of a single-use double-lumen tube (DLT) combined with a reusable bronchoscope were compared to a single-use DLT with an integrated single-use camera. Camera DLTs exclude or minimize the need for a bronchoscope to verify correct tube placement during one-lung ventilation. The life cycle assessment shows that the materials and energy used and needed for personnel protective equipment and cleaning of the reusable bronchoscope contribute significantly to CO 2 -equivalent emissions. To ensure the sustainable choice of equipment this aspect must not be overlooked. Secondly, future reuse of plastic waste materials from the use can contribute significantly to better environmental performance.