1. 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

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

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

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

5. Tracheal Anatomy and Device Placement

6. Project Definition Come up with one device that conforms to the following requirements: Come up with one device that conforms to the following requirements: 1.Provide rapid temporary airway with manual jet ventilator 2.Provide means to perform retrograde intubation 3.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retrograde intubation through separate lumen in catheter that allows for insertion of wire to be eventually withdrawn from mouth and used for ET tube insertion 4.Safely combines these two sequential procedures (one being rapid and temporizing while the other is more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

7. Market Analysis Ability for use in any emergency department, most likely a Level 1 Trauma Center (VUMC) Ability for use in any emergency department, most likely a Level 1 Trauma Center (VUMC) Any case with upper airway compromise Any case with upper airway compromise Total cost, disposable and non-disposable equipment approaches $1,000 Total cost, disposable and non-disposable equipment approaches $1,000 Disposable (tubes, catheters) = $250-300 Disposable (tubes, catheters) = $250-300 Non-disposable (laryngoscope blades, oxygen regulator, jet ventilator) = $600 Non-disposable (laryngoscope blades, oxygen regulator, jet ventilator) = $600

8. Current Status Researching Researching –History of TTJV and retrograde intubation –Costs of procedures at various hospitals Setting up times for ER observation Setting up times for ER observation Develop more regular meeting schedule with advisor Develop more regular meeting schedule with advisor

9. Future Work Research more on current devices’ traits and brainstorm proposed designs Research more on current devices’ traits and brainstorm proposed designs Investigate the FGH engineering shop’s progress regarding buying a rapid prototype machine next semester Investigate the FGH engineering shop’s progress regarding buying a rapid prototype machine next semester

10. Questions???