DOI: 10.1097/CCM.0b013e31821488d7

,  

Issn Print: 0090-3493

Publication Date: 2011/05/01


Print

Cuff damage during emergency intubation with the Airtraq optical laryngoscope in the prehospital setting

Helmut Trimmel; Wolfgang G. Voelckel

    loading  Checking for direct PDF access through Ovid

Excerpt

We greatly appreciate the letter received from Dr. Xue et al (1) addressing the reasons for failed Airtraq (Prodol Meditec, Vizcaya, Spain) intubation in our prehospital study. We have also been surprised about the high frequency of cuff damage when the Airtraq was used for emergency airway management. Interestingly, we observed this problem rather infrequently when using the device in the operating room. The endotracheal tubes (Ruesch, Kernen, Germany) used in our study had internal diameters of 7 and 8 mm. We speculate that multiple factors contribute to this finding.
To our knowledge, this is the first study evaluating the Airtraq in the prehospital environment. Airway management in the street is a scenario that implicates an extensive distress to the entire rescue squad. Due to the necessity of rapid airway management, emergency personnel are under significant pressure when preparing the device within a short time. Since we noticed the problem of cuff damage during the first few months of the ongoing study, we optimized the preparation of the device. First, lubrication employing a silicon spray (Seidel Medizintechnik, Buchendorf, Germany) within the package was replaced by thorough application of a lubricant oil (MCT oil, Flocare lubricant, Nutricia, Fribourg, Switzerland). Second, on the basis of the observation that even minor amounts of air may put the cuff at risk when it is withdrawn during the intubation maneuver, we requested active deflation of the cuff. Advancing and retracting the tube are typical movements during endotracheal intubation under direct laryngoscopy. When the Airtraq is used, manipulating the tube as mentioned before may thus cause cuff damage. As such, the observed phenomenon could be overcome with better handling of the Airtraq (i.e., manipulating the entire device rather than the tube). Third, the tube was loaded from the distal end to minimize cuff contact with the Airtraq channel.
The above-mentioned aspects were summarized in a guideline and communicated with the rescue teams during the ongoing study. Consequently, the absolute numbers of cuff damage occurrences (n = 10) declined, but damage was not abolished completely (8 of 53 before vs. 2 of 53 after adjustment of the guideline). This sheds additional light on the necessity of intensive training and proper preparation of the devices used in the emergency setting.
This study was supported, in part, by Habel Medizintechnik, Vienna, Austria, supplying 50% of the Airtraq devices used in the study. The authors have not disclosed any potential conflicts of interest.
    loading  Loading Related Articles