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, 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
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

5. Tracheal Anatomy and Device Placement

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retrograde intubation through separate lumen in catheter that allows for insertion of wire to be eventually withdrawn from mouth and used for ET tube insertion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

7. 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

8. Equipment

9. 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

10. 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

11. 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)

12. Questions???