The Science Journal of the American Association for Respiratory Care

1997 OPEN FORUM Abstracts

AN EVALUATION OF THE VOLUME AND PRESSURE DELIVERY CHARACTERISTICS OF THE FRENCH POCKET EMERGENCY AIRWAY (FPEA) AND THE NU-TRAKE (NT) CRICOTHYROIDOTOMY DEVICE.

Tim Op't Iolt, Fd.D., R.R.T. and Fred Hill M.A., R.R.T. Univ. of South Alabama, Mobile, AL.

Background: Cricothyroidotomy, the puncture of the cricothyroid cartilage to create an airway, is usually performed in an emergency situation wherein the victim has clenched teeth, blood or vomit obscuring visualization of the upper airway, severe maxillofacial injuries, inaccessibility because the victim was trapped, severe burns, laryngeal edema from an insect bite, or failure of the Heimlich maneuver. The present report describes a new cricothyroidotomy device that is packaged as a key ring attachment. This new device is compared with the currently available NT cricothyroidotomy device. We sought to determine the volumes and pressures generated with this new device compared to the NT. The FPEA is a four-piece device that is disassembled for cricothyroidotomy, then reassembled for patient ventilation. The NT is a needle cricothyroidotomy device, that uses airways of increasing size for patient ventilation. Methods: Each device was punctured into a piece of corrugated tubing closed at one end, simulating a cricothyroid membrane. The tubing was adapted to a training test lung (TTL) which was ventilated through each device by 1) a mechanical ventilator set at a tidal volume of 0.8 L, 8-16 breaths/min. and flows of 30 and 50 L/min, 2) a manual resuscitator at rates of 10-20 breaths/min, and 1-2 sec. inspiratory times and 3) by mouth-to-device at 10, 12, and 20 breaths/min. and 10 and 20 cm H_{2}O. These settings are consistent with Advanced Cardiac Life Support guidelines. Pressures, flows, and volumes were measured by the TTL. Experience: The device was only tested in-vitro. Clinical trials were not part of this protocol. Evaluation Results: The FPEA delivered 0.704 ± 0.003 L to the test lung at all rates and flows. The NT, with tape wrapping to cover the leaks inherent in the device delivered 0.475 ± 0.035 L to the test lung at all rates and flows. The FPEA delivered 0.535 ± 0.013 L and the NT delivered 0.429 ± 0.005 L during manual ventilation with the resuscitator. Tidal volume was approximately 0.9 L with the FPEA during mouth-to-device breathing at a peak pressure of approximately 20 cm H_{2}O and 0.45 L at a peak pressure of 10 cm H_{2}O. The NT volumes were 0.704 L and 0.626 L at 20 cm H_{2}O and 0.481 L at 10 cm H_{2}O with mouth-to-device ventilation. Using the FPEA, intrinsic PEEP began to develop at 10 breaths/minute and actual flow of 27.5 L/min. When flow was increased to 44 L/min., the intrinsic PEEP was eliminated. Higher intrinsic PEEP occurred at each higher breath rate at a set flow of 30 L/min. which decreased with a set flow of 50 L/min.. The highest intrinsic PEEP was 4.5 cm H_{2}O at 16 breaths/min. and set flow of 30 L/min. This decreased to 1.8 cm H_{2}O when flow was increased to 50 L/min.. Conclusions: The FPEA delivered consistent tidal volumes to the test lung at all rates and flows selected when mechanical ventilation was used. Ventilation was consistent when ventilating with a manual resuscitator and with mouth-to-device ventilation. Results demonstrate that the volumes through the FPEA were consistently higher than those delivered through the NT due to leaks inherent in the NT, despite wrapping the NT with cloth adhesive tape. While both devices appear to create a patent airway, ventilation through the FPEA was greater, as it did not leak and its seal with the simulated airway was superior to that of the NT. Clinically inconsequential intrinsic PEEP developed when the FPEA was used. Both the NT and FPEA provide a 15mm O.D. adapter for attachment of ventilatory devices.

OF-97-181

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