Rescue Endotracheal Tube (Reinforced)- for intubation through a Laryngeal Mask Airway

1. A “can’t-intubate-can’t-oxygenate” (CICO) scenario when a laryngeal mask has been placed as a rescue device and works well enough to oxygenate the patient but there is a need for endotracheal intubation
2. After several unsuccessful intubation attempts with direct laryngoscopy
3. After unsuccessful intubation attempts with video laryngoscopy
4. Elective use to train for using the technique in an emergent CICO scenario
5. Conversion from laryngeal mask to endotracheal tube intraoperatively, for example:
   • where anaesthesia was started with a laryngeal mask but the device subsequently fails / the seal fails
   • when muscle relaxation becomes necessary and the anaesthetist does not feel confident to ventilate a paralysed patient with a laryngeal mask

1. Patients with an aspiration risk

THE RESCUE ETT IS PRESENTED AS A PACK CONTAINING:

1. Modified endotracheal tube with a posterior facing bevel, curved atraumatic tip and removable 15mm ISO connector
2. Airway tubing having a fixed 15mm ISO connector at the proximal end and a connector to mate with the distal end of the endotracheal tube

GENESIS RESCUE ETT IS AVAILABLE WITH REINFORCED AND CLEAR PVC ENDOTRACHEAL TUBES.

Modifications made to the endotracheal tubes:

1. The length of the endotracheal tube connected to the airway tubing is sufficient that the endotracheal tube may be passed through the shaft of the LMA and protrude far enough beyond the LMA to position the ETT cuff safely below the vocal cords
2. The bevel is posterior facing with a curved atraumatic tip providing a greater initial success rate of intubation and preventing hang up on laryngeal structures. The curved atraumatic tip abutting against the fibreoptic bronchoscope eliminating the gap causing laryngeal hang-up
3. The 15mm ISO connector is removable
4. The inflation line connecting the cuff of the ETT to the pilot balloon and inflation valve is of sufficient length to allow the laryngeal mask to be removed over the ETT and the ETT disconnected from the Airway tubing before the inflation line, pilot balloon and inflation valve are delivered through the shaft of the LMA
5. The PVC has a soft consistency preventing the need for thermosoftening

A METHOD OF USE WITH A FIBREOPTIC BRONCHOSCOPE (FOB)

1. The LMA is used to secure the airway, the anaesthetic machine connected, ventilation and oxygenation are confirmed
2. The ETT and the airway tube must be easily disconnected. If the connection is too firm, add water-soluble lubricant to the connector
3. The appropriately sized rescue ETT is selected (the ETT selected must not be forced through the shaft of the LMA as damage to the cuff of the ETT may occur)
4. The 15mm ISO connector is removed from the ETT and is connected to the airway tubing. The proximal end of the ETT and cuff is well-lubricated
5. A FOB with a working length of at least 60cm and sufficient diameter to abut against the curved atraumatic tip of the ETT is chosen
6. A self-sealing connector with a sidearm is placed over the 15mm connector of the airway tubing
7. This complex is then loaded over the FOB with the FOB tip just proximal to the tip of the ETT
8. The LMA is disconnected from the anaesthetic machine. The ETT/airway tube is then connected to the anaesthetic machine and the distal ETT inserted into the shaft of the LMA. The cuff of the ETT is inflated in the shaft of the LMA once the the ETT tube tip is 2cm out of the distal LMA aperture (eg with a #4 i-Gel shaft length = 19cm when ETT is at 21cm measured at the proximal end of the i-Gel) allowing continued ventilation
9. The FOB is then advanced through the vocal cords and into the trachea
10. The cuff of the ETT is deflated and the ETT/airway tubing is railroaded over the FOB until the cuff of the ETT is a safe distance below the vocal cords and the cuff is reinflated
11. The ETT/airway tubing is stabilized. The LMA cuff is deflated and it is withdrawn carefully over the ETT/airway tube
12. After confirming that the ETT is still correctly positioned, the FOB is removed
13. The ETT and airway tube are disconnected, the 15mm ISO connector is reinserted into the distal ETT and the anaesthetic machine is connected
14. The airway tube is removed from the shaft of the LMA and then the inflation line, pilot balloon and inflation valve are delivered through the shaft of the LMA