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Spritztube and C-MAC® VS Video Stylet for airway management

  • Centre for Medical Sciences - CISMed, University of Trento, Via S. Maria Maddalena 1, 38122 Trento, Italy;
Topic: Quality and safety (incorporating human factors)
ID ABS WEB: 90508
Carmine Della Vella
, Ryan J. Thompson
, Karen Serrano
, Matthias L.
, James Ducanto
a Cattolica del Sacro Cuore, Rome,
University of Wisconsin, Madison, USA;
University North Carolina,
Chapell Hill, USA;
University of Wisconsin, Madison, USA;
Aurora St.
Luke s Medical Center, Milwaukee, USA
E-mail address: CDELLAVELLA@MSN.COM (C. Della Vella).
Background and goal of the study: The Suction-Assisted Laryngoscopy
Assisted Decontamination (SALAD) simulation system utilizes an airway
modied mannequin. This device is used to train anesthesiologists and
others who face the challenges of emergency airways, facilitating
competence with use of suction to manage emesis and bleeding often
encountered in the management of emergency airways.
Methods: The SALAD utilizes a airway mannequin that is adapted with
hardware store equipment. The simulated vomit is created with grocery
store white vinegar mixed with xantham gum powder. To assess the
effectiveness of the SALAD simulator, a pre- and post- survey was con-
ducted among a varied interprofessional group attending an airway
management conference both before and after interacting with the SALAD
Results: 22 providers, including 7 CRNAs, 7 Anesthesiologists, 3 Emergency
Medicine Physicians, 2 Medical Students, 1 Respiratory Therapist, 1 Nurse
Practitioner, and 1 Nurse went through the course and answered the
before-and-after survey. 17 of the 22 (77%) had used simulation to learn or
practice airway management, but none had ever used simulation to learn
to manage a vomiting or hemorrhaging patient. The average condence
score in managing the airway of a vomiting or hemorrhaging patient
improved from 2.73 to 4.00 after use of the simulator. Similarly, the
average comfort with suction devices and techniques score improved from
3.14 to 3.82. The average usefulness score was 4.55, and the average re-
alism score was 4.59.
Discussion: This novel airway simulation system requires the trainee to
suction while attempting to visualize airway structures and place an
endotracheal tube. This system thus recreates the dynamic challenges
associated with emergency airways, facilitating trainee competence in
using suction to clear the airway of an actively vomiting and/or bleeding
Conclusions: Trainees overwhelmingly rated the experience as positive
and shared anecdotal reports that the skills gained in this simulation
helped them in a subsequent clinical encounter.
Topic: Clinical science
ID ABS WEB: 92396
Silvia De Rosa
, Massimiliano Sorbello
, Anna Piccolo
, Maurizio
, Paolo Gennaro
, Stefano Checcacci Carboni
St Bortolo
Hospital, Department of Anesthesia and Intensive Care, Vicenza, ITALY;
Azienda Ospedaliero Universitaria (AOU) Policlinico Vittorio Emanuele,
Department of Anesthesia and Intensive Care, Catania, Italy
E-mail address: DEROSA.SILVIA@YMAIL.COM (S. De Rosa).
Background and goal of the study: The C-MAC®Video Stylet (VS) is a new
type of video endoscope that, through its semi-exible sheath and
deectable tip, combines the advantages of both rigid intubation tele
scopes and exible intubation endoscopes.In our center, we developed a
new ssupraglottic airway device (SAD) able to combine the ability to
perform both SAD ventilation and oro-tracheal breoptic intubation using
the same device. We conducted a prospective observational pilot study to
assess the performance of the combined use of ST and C-MAC®VS.
Abstracts / Trends in Anaesthesia and Critical Care 23 (2018) 10e5032
Methods: We evaluated the use of the combined use of ST and C-MAC®VS
from August to September 2018. Patients characteristics(including ASA
grade and features predictive of a difcult airway), anaesthetic technique
and evaluation of ST- C-MAC®VS performance.Primary outcome was the
success of intubation with the combined use of ST and C-MAC®VS.Se-
condary outcomes included the ease of ST insertion, ease of C-MAC®VS
insertion, time required,number of attempts, quality of view, quality of
image on monitor screen,side effects and complications.
Results: Thirty-six adult patients undergoing elective surgery requiring
endotracheal intubation were recruited. The overall success rate but also
the success rate for those with predictors of difcult airway was 100%.Easy
tube insertion was reported by 97.3% of anaesthetists and 95% reported
easy scope insertion.The median time required to perform the endotra-
cheal intubation was 15(5-60) sec.The quality of the image was considered
as either goodor satisfactoryby 99% of anaesthetists;94.4% rated the
quality of view as clear. We had no evidence of trauma. Two cases were
complicated by airway oedema at extubation.
Conclusions: The use of ST is associated with with a high intubation success
rate, easy C-MAC®VS insertion and easy intubation when used for adult
patients in an elective setting. It carries a low risk of airway trauma and is
suitable for use in patients with both normal and predicted difcult airways.
Topic: Case reports
ID ABS WEB: 91797
Alessandro Rigobello
, Roberto Squaquara
, Andrea Abbate
, Silvia De
St Bortolo Hospital, Department of Anesthesia and Intensive Care,
Vicenza, Italy;
St Bortolo Hospital, Department of Maxillofacial Surgery,
Vicenza, Italy
E-mail address: DEROSA.SILVIA@YMAIL.COM (S. De Rosa).
Background and goal of the study: Penetrating Zone II neck trauma may
cause impending asphyxiation from a major injury to the trachea.Ther-
efore, a loss of the airway in Zone II may occur secondary to tracheal de-
viation or compression from a hematoma resulting from an injury to the
carotid artery or internal jugular vein. In this report, we present the case of
a patient who presented penetrating Zone II neck trauma and in which we
performed a translaryngeal intubation through wound track.
Methods: A 75-year-old male patient with three stabs wound to the neck
was transferred directly to the OR by BRC.The time from injury to arrival of
BRC was 8 minutes. Blood loss at the scene was estimated less of 30%.
Prehospital interventions included application of pressure dressing and
the delivery of oxygen by a nonrebreather facemask. Intensivists were
alerted by Emergency Medical System approximately 1 minute prior to the
patients arrival. On arrival, the patient was transferred directly to the
operating room.He was conscious, tachicardic, with a systolic blood
pressure of 140 mmHg and in severe respiratory distress, with clinical
features of upper airway obstruction.Blood emanated from both the neck
wound and mouth.
Results: Midazolam and Rocuronium were admistered.Direct laryngoscopy
revealed no recognizable anatomy due to the presence of blood and
anatomic distortion of the upper airway. Translaryngeal intubation
through wound track was performed in few seconds and a size 8 endo-
tracheal tube was readily inserted into the trachea. Appropriate ETT po-
sition was conrmed with a colorimetric carbon dioxide detector.In OR,
emostasis and reconstruction for planes with anchorage of the epiglottis at
the base of the tongue was performed.A tracheostomy was performed
below the level of the injury.
Conclusions: Direct introduction of an ETT through the neck wound shoul d
be considered early if the airway is transected.
E.E. Moore, D.V. Feliciano and K. Mattox. Trauma, Eighth Edition. 2017
Topic: Case reports
ID ABS WEB: 92597
Maria Elena De Piero, Marco Vergano, Carlo Frangioni, Diego
Artusio, Sergio Livigni. Departement of Anaesthesia, Intensive Care and
Emergency, San Giovanni Bosco Hospital, Turin, Italy
E-mail address: MARIELEDEP@GMAIL.COM (M.E. De Piero).
Background and goal of the study: Airway management and mechanical
ventilation present unique challenges for anaesthetic care of patients
requiring complex thoracic surgical procedures.
Resection of cervical lesions causing tracheal compression or extensive
lung resection with poor contralateral lung function is rarely performed.
Advances in ECMO have allowed safe performance of complex thoracic
surgical procedures otherwise impossible.
Methods: Between December 2015 and May 2018 six patients underwent
elective VV-ECMO placement for thoracic surgery.
Two underwent elective ECMO positioning before resection of a multi-
nodular goitre with mediastinal extension and severe tracheal compres-
sion; two required urgent ECMO positioning following accidental
tracheobronchial lesions and two underwent pneumonectomy during VV-
ECMO support for ARDS.
In three patients femoro-femoral VV-ECMO conguration was mandatory
due to previous or concurrent head and neck surgery; in the others fem-
oro-jugular conguration was chosen.
None of them developed ECMO-related complications and no major
bleeding occurred.
All the patients with surgery for goitre or tracheobronchial stula was
successfully weaned from ECMO, while the two with extensive lung
resection died due to the persistence of the contralateral lung damage.
Results: Complex airway management can pose a risk for airway damage
or can provide inadequate gas exchange during one-lung-ventilation.
Institution of VV-ECMO ensures a complete control over the adequacy of
gas exchange even before the induction of general anaesthesia.
Mechanical ventilation can be then reduced or even stopped during sur-
gery, if the cardiac function allows it and maintaining adequate gas
Intraoperative extracorporeal support allows surgical access to anatomi-
cally difcult sites such as the posterior tracheal wall.
Conclusions: VV-ECMO can be considered for the management of patients
undergoing complex thoracic procedures in absence of compromised
cardiac function.
VV-ECMO is a simpler and less invasive approach and avoids the risks of
arterial injury.
Abstracts / Trends in Anaesthesia and Critical Care 23 (2018) 10e50 33
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