Apneic preoxygenation without nasal prongs: the “Hungarian Air Ambulance method”

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Laszlo Gorove³  Andras Petroczy¹  Laszlo Hetzman³  Attila Eross² 

[1] Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Kutvolgyi ut 4, Budapest H-1125, Hungary;Department of Anaesthesiology and Intensive Care, Medical Centre, Hungarian Defence Forces, Robert Karoly korut 44, Budapest H-1134, Hungary;Hungarian Air Ambulance Nonprofit Ltd., Legimentok utca 8, Budaors H-2040, Hungary

关键词: Rapid sequence intubation;    Intubation;    Helicopter emergency medical service;    Prehospital;    Apneic oxygenation;    Apneic preoxygenation;    Preoxygenation;   

Others  :  1235664
DOI  :  10.1186/s13049-016-0200-0

 received in 2015-12-23, accepted in 2016-01-14,  发布年份 2016

【 摘 要 】

The Hungarian Air Ambulance has recently adopted oxygen supplementation during laryngoscopy, also known as apneic preoxygenation, to prevent desaturation during rapid sequence intubation. Despite its simplicity the nasal cannula method has some limitations relevant to our practice. First, the cannula can dislodge if the head is manipulated during preparation or intubation, especially if nasopharyngeal airways are chosen to maximise preoxygenation. Second, the method is incompatible with continuous nasal suctioning required in severe maxillofacial trauma. Third, if only one oxygen source and one competent assistant is available, a situation common during prehospital missions, the extra tube swap needed for continuous oxygen supplementation makes the procedure more complex and prone to error. We report a new method that provides comparable oxygen supplementation to the nasal cannula method, but at the same time eliminates the problems mentioned above and is easier and quicker to perform. It requires the intubator to cut and insert the tubing of the non-rebreather mask into the nasopharyngeal airway, thus providing direct pharyngeal insufflation. The method is applicable to every patient who has at least one nasopharyngeal airway inserted at the time of laryngoscopy and it only requires a pair of scissors.

【 授权许可】

   
2016 Eross et al.

【 图 表 】

Fig. 1.

Fig. 1.

【 参考文献 】

• [1]Teller LE, Alexander CM, Frumin MJ, Gross JB. Pharyngeal insufflation of oxygen prevents arterial desaturation during apnea. Anesthesiology. 1988; 69:980-982.
• [2]Taha SK, Siddik-Sayyid SM, El-Khatib MF, Dagher CM, Hakki MA, Baraka AS. Nasopharyngeal oxygen insufflation following pre-oxygenation using the four deep breath technique. Anaesthesia. 2006; 61:427-430.
• [3]Baraka AS, Taha SK, Siddik-Sayyid SM, Kanazi GE, El-Khatib MF, Dagher CM et al.. Supplementation of pre-oxygenation in morbidly obese patients using nasopharyngeal oxygen insufflation. Anaesthesia. 2007; 62:769-773.
• [4]Ramachandran SK, Cosnowski A, Shanks A, Turner CR. Apneic oxygenation during prolonged laryngoscopy in obese patients: a randomized, controlled trial of nasal oxygen administration. J Clin Anesth. 2010; 22:164-168.
• [5]Lee SC. Improvement of gas exchange by apneic oxygenation with nasal prong during fiberoptic intubation in fully relaxed patients. J Korean Med Sci. 1998; 13:582-586.
• [6]Christodoulou C, Mullen T, Tran T, Rohald P, Hiebert BM, Sharma S. Apneic oxygenation via nasal prongs at 10 L/min prevents hypoxemia during elective tracheal intubation. Chest. 2013; 144(4_MeetingAbstracts):890A.
• [7]Weingart SD, Levitan RM. Preoxygenation and Prevention of Desaturation During Emergency Airway Management. Ann Emerg Med. 2012; 59:165-175.
• [8]Wimalasena Y, Burns B, Reid C, Ware S, Habig K. Apneic Oxygenation Was Associated With Decreased Desaturation Rates During Rapid Sequence Intubation by an Australian Helicopter Emergency Medicine Service. Ann Emerg Med. 2015; 65:371-376.
• [9]Soti A, Temesvari P, Hetzman L, Eross A, Petroczy A. Implementing new advanced airway management standards in the Hungarian physician staffed Helicopter Emergency Medical Service. SJTREM. 2015; 23(3). doi:10.1186/s13049­014­0081­z
• [10]Yao HH, Tuck MV, McNally C, Smith M, Usatoff V. Gastric rupture following nasopharyngeal catheter oxygen delivery - a report of two cases. Anaesth Intensive Care. 2015; 43:244-248.