Apneic preoxygenation without nasal prongs: the "Hungarian Air Ambulance method"

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 cannul...

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Bibliographic Details
Published in:Scandinavian journal of trauma, resuscitation and emergency medicine resuscitation and emergency medicine, 2016-01, Vol.24 (4), p.5-5, Article 5
Main Authors: Eross, Attila, Hetzman, Laszlo, Petroczy, Andras, Gorove, Laszlo
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Air Ambulances
Airway management
Catheters
Child
Consciousness
Emergency medical care
Emergency service
Female
Health aspects
Hospitals
Humans
Hungary
Iatrogenesis
Intubation
Intubation, Intratracheal - methods
Laryngoscopy
Male
Middle Aged
Obesity
Oxygen - administration & dosage
Oxygen saturation
Patients
Suctioning
Trauma
Young Adult
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Summary: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.
ISSN:1757-7241
1757-7241
DOI:10.1186/s13049-016-0200-0