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Novel Hybrid Airway technique with Dr Jim Du Canto

Thumbnail image for A Guide to Intubating through the Intubating Laryngeal Airway by James DuCanto

Jimmy D is back with more videos on intubation via a supraglottic airway and a really novel twist!

Jimmy excels once again in his passion for demonstrating novel and resilient airway management techniques. Here are two videos taken in his elective OR list. All videos we post have been consented by the patients for medical education purposes. Come and spend a session in JImmy’s OR!

Incredible stuff, right? Whats so novel about what you just saw?

1.The LMA Unique utilised as the supraglottic airway is almost ubiquitous in one form or another. It is essentially a disposable version of the original LMA Classic. In other words almost everywhere that needs to provide emergency airway management will have one

2.Note the swivel connector used to attach ventilator circuit and insert bougie. Find one of these cheap connectors and keep it in your pocket. Scott Weingart has a nice description of using one of these here for suctioning during direct laryngoscopy. This connector will allow you to continuously ventilate during bougie insertion as well with this hybrid airway technique Jimmy demonstrates.

3.Note the gas analyser monitor on the videos and the Inspired and Expired values. This is what Jimmy talks about in using much more accurate “barometers” of adequate ventilation. If your expired O2 is > 94%, you have a large reservoir of oxygen sitting in your lungs = lots of safety during apnoea

4. The CrankShaft MAneuver I am going to name the DuCanto maneuver but this was his novel solution to a problem we encountered in testing this technique. As the bougie exits the LMA, it enters the larynx at an acute angle and hits the anterior wall of the tracheal entrance. There are a number of things you can do like withdrawing the LMA to make the exit angle less acute but this crankshaft maneuver works well too. I tried it out on a Frova intubating bougie which is hollow and it did not work so well as the haemostat crushed the bougie shaft and made it difficult to rotate. A solid bougie like the Portex one Jimmy uses in the video is recommended.

5. I call this novel hybrid concept the Mount Everest strategy of emergency airway management. If you were to consider how one might tackle the highest mountain in the world, you should realise that altitude related hypoxia is the big killer in this situation. Just like it is for our critical airway patients. How do the experienced climbers tackle Mt Everest? They lay siege to the mountain, establish base camps and higher rest camps with a staged approach of acclimatisation. Any attempts to rush this time honored process are often fraught with disaster and high risk. Similarly in our high risk hypoxic patients we need to lay siege to enemy hypoxia, establish a base camp of reliable and secure oxygenation ( preoxygenation) then setup our first stage of the climb ( by inserting a LMA or SGA). This gets us closer to the summit but allows for reoxygenation and breathing space to make the next staged ascent. Of course you can just try to intubate as quickly as possible, or using the climbing analogy, try to summit in one ascent. Thats possible but is it safe, is it acceptable risk? Not so sure…

Hope you airway interested providers out there have enjoyed this episode as much as I have.

Send in your comments and please thank Jimmy for all this work he is doing to educate us all on his discovery and exploration of resilient airway techniques to assist the emergency provider

regards

Minh

3 Comments Post a comment
  1. kangaroobeach #

    Played around with this on a mannikin today using

    – Frova and Portex bougies
    – KingVision VL with non-channelled blade
    – cLMA, pLMA and the Air Q II

    The blade with the KingVision works “OK” but I wonder if would be better with a McGrath…of course the Levitan would obviate this.

    It’s not bad! Which I’d picked up more of those swivel bronch adaptors when I was up in the big teaching hospital….

    May 23, 2012
  2. kangaroobeach #

    Nice stuff

    Fiddled around with the mannikin today, using a variety of

    – Frova and Portex bougie
    – cLMA, pLMA and AirQ II LMAs
    – Kingvision VL non-channelled blade

    It works!

    Might be better off using a less bulky blade like the McGrath,..or better still the Levitan

    Now, got to get me a bucketload of those swivel bronch adaptors from the nearest ICU…

    May 23, 2012
  3. Very hard to see anything that is going on in actual fact, let alone swivel adapter. Leftward BURP maneuver was wrong. Visualization was hit or miss.

    October 2, 2012

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