1. 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 and Pediatrics, VUMC

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

3. 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

4. Retrograde Intubation (RI)
Performed via second puncture hole in cricothyroid membrane
Catheter is aimed cephalad instead of caudad
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

5. A picture is worth 1,000 words…
Transtracheal Jet Ventilation Procedure
Retrograde Intubation
Images Courtesy:

6. Tracheal Anatomy and Device Placement

7. 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retrograde intubation through separate lumen in catheter that allows for insertion of wire to be eventually withdrawn from mouth and used for ET tube insertion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

8. Market Analysis
Ability for use in any emergency department, most likely a Level 1 Trauma Center (VUMC)
Any case with upper airway compromise
Total cost, disposable and non-disposable equipment approaches $1,000
Disposable (tubes, catheters) = $
Non-disposable (laryngoscope blades, oxygen regulator, jet ventilator) = $600

9. Recent Progress
Original prototyping with heat-shrink tubing did not work (too rigid)
Worked with Dr. White last Tuesday evening; great real-world experience and time to work on project with him
Decided that original design option #1 was unfeasible
Came up with new option, as well as slight modification to our original design #2
Flow testing with central line cath. and angiocath. on ET tube with glove attached
By Dr. White’s standards, sufficient inflation capability reached even down to a 20G catheter
Two 20G catheters easily put together to create a double lumen catheter
Determined that Martech Medical has capability to extrude custom catheters to any specification – ordered sample catheters that should be in today/tomorrow

10. Equipment

11. Proposed Design #1 Martech Medical www.martechmedical.com
Double Lumen Split Catheter
Short (<1cm) insertion needle
Inserted perpendicular to cricothyroid membr.
Marked catheter introduced
One lumen flexes caudad, one cephalad
Instant ventilation and wire insertion capability

12. Proposed Design #2
Typical marked double lumen, central line-type catheter
Inserted toward head
Normal retro. intubation possible
Catheter pulled out slightly, flexed (not kinked) to point hole/lumen caudad
Catheter pushed back in for immed. ventilation
Wire insertion next to provide for retrograde intubation
Would ultimately require manufacture of new double lumen catheter
Area of larger bore
and inner lumen (rigid
until just distal of exit)
Oxygen exit
Oxygen entry

13. Future Work
Receive shipment of sample catheters, test for style/design feasibility on throat model
Test samples on pig or dog (similar anatomy and proportions)
Begin talks with Martech rep. about building a prototype to our specs.
Begin work on paper and putting together final poster presentation

14. Questions???