This fantastic video was sent to me by my airway buddy, Darren Braude, MD.
The resident is Naomi Bancroft, MD.
This was a size 4 Ambu AuraGain with a 7.0 ET tube
Patient had suffered an OHCA secondary to a GIB. AuraGain placed by the Albuquerque Fire Department with ROSC obtained in the field. Patient had initial resuscitation including vent management, blood, octreotide, arterial line, femoral coolguard line and pressors performed with the AuraGain in place as patient was oxygenating and ventilating perfectly.
Update:
@ketaminh tipped us off to a 2nd video (published the same day) that demonstrates the technique in the OR from fibroanestesia
Editor-in-Chief, at EMCrit.org
An ED Intensivist from NY.
Professor
Chief, Division of Emergency Critical Care
Director, Resuscitation and Acute Critical Care Unit
Stony Brook Medicine
Stony Brook, NY, USA
No conflicts of interest (coi).
Professor
Chief, Division of Emergency Critical Care
Director, Resuscitation and Acute Critical Care Unit
Stony Brook Medicine
Stony Brook, NY, USA
No conflicts of interest (coi).
Latest posts by Scott Weingart, MD FCCM (see all)
- EMCrit 290 – Decompensated Hypothyroidism and Myxedema with Dr. Arti Bhan - January 23, 2021
- EMCrit 289 – Ketamine Only Intubation Paper with Brian Driver - January 12, 2021
- EMCrit 288 – Neurogenic Shock & Should we be Using Vasopressors for Hemorrhagic Shock? - December 29, 2020
Good video. One thing that might make things easier is to use a generous amount of silicone spray (or silicone jelly) on the surface of your bronchoscope. We find that the silicone spray allows the plastic to slide like butter along the bronchoscope.
Careful not to let the spray end up on the floor! it’ll be an ice skating rink.
big debate in the anesthesia world as to what is truly safe fro bronch lubrication. ?s as to whether silicone is actually safe or not.
I can’t vouch for its safety but I can definitely vouch for its effectiveness. When I have an unsecured airway I’ll err on the side of doing everything to optimize my success – in exchange for the tiny possibility of causing harm in the future.
In the pre-hospital setting we use EGDs mainly in cardiac arrests, then intubate after we have ROSC. We currently use the I-Gel and my issue is that we can only get a 6.0ETT through the I-Gel. If the patient is likely to be a easy intubation using DL or VL, I will generally opt to pull the tube and risk 10-15 seconds off the bag to get a tube that will deliver the volumes I think the patient needs. If they look to be a difficult intubation then I might consider intubating through the I-Gel but most likely will leave… Read more »
Say you don’t have a bronch/ambuscope to make this transfer. Thoughts on using a bougie instead? Or even blind ETT insertion?