Project Undertaken by: Fritz Haimberger Emergency Airways Modification of Transtracheal Jet Ventilation and Retrograde Intubation Techniques BME 272 Senior Design Group 20 Project Undertaken by: Fritz Haimberger Advisor: Dr. Steven J. White, Asst. Professor of Emergency Medicine, VUMC

Background Emergency Airway Maintenance Pre-hospital care PtL Combitube Endotracheal (ET) Tube Nasotracheal Tube Laryngeal Mask Airway Hospital Care ET tube

Transtracheal Jet Ventilation (TTJV) Used to rapidly initiate ventilation in a trauma case with difficult airway access in the ER Temporizing measure until a patent airway can be secured via ET tube placement Usually followed by retrograde intubation

Retrograde Intubation Performed via second puncture hole in cricothyroid membrane Catheter is aimed cephalad instead of toward the lungs Wire inserted through catheter, advanced up trachea and out mouth ET tube placed over guide-wire and advanced down the windpipe into position for use as a patent airway Video Video2

Tracheal Anatomy and Device Placement

Project Definition Come up with one device that conforms to the following requirements: Provide rapid temporary airway with manual jet ventilator Provide means to perform retrograde intubation Accomplishes retrograde intubation through separate lumen in catheter that allows for insertion of wire to be eventually withdrawn from mouth and used for ET tube insertion Safely combines these two sequential procedures (one being rapid and temporizing while the other is more time-consuming yet definitive) into one step that significantly decreases the composite risk

Progress Completed Thus Far Researching History of TTJV and retrograde intubation Materials involved in catheter design One ER observation on a Friday night in December, very productive – this and previous meeting led to two possible design ideas Manipulated catheter and jet ventilator to get better idea of procedure and materials

Equipment

Proposed Design #1 (modification of Dr. White’s original thought) Thread to pull guide tube Tube in retroflexed position TTJV Catheter Red=oxygen exit to lungs Blue=guide wire insertion

Proposed Design #2 Typical TTJV catheter Inserted toward lungs Normal TTJV ventilation Catheter pulled out slightly, flexed (not kinked) to point hole cephalad Catheter pushed back in and guide wire inserted for RI procedure Armoring of the Catheter here Guide wire insertion Hole for guide wire exit

Future Work Schedule more ER observation time in hopes of catching the TTJV and RI procedures being done on a human Arrange for using the VUMC advanced skills lab or airway laboratory Test two proposed designs for efficacy of each and find out how each performs on a “human airway” (using a mannikin)

Questions???