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Expanded Guide:
Aintree Rescue Intubation through the LMA

Rescue LMA placed? But need a protected airway?

 

Take the following steps to fiberoptically intubate the patient using the Aintree. Note that there are numerous methods for fiberoptically converting an LMA to an ETT. The following method is easy to learn, maximizes continuous ventilation time, and has a versatility that makes it compatible with virtually every type of the 40+ FDA approved LMAs on the market (the notable exception is the Teleflex Supreme LMA, as this LMA's lumen is simply too small and will not readily accommodate an Aintree catheter).

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Read on to learn more.

PART 1: LMA PLACEMENT

Rescue LMA reestablishes ventilation.

​​​​Following failed efforts at intubation and mask ventilation, an LMA can reestablish ventilation and oxygenation. The next steps can allow for the safe transition of the rescue LMA to a secure airway with an ETT.

Part 2: Equipment Preparation

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Gather equipment. Call for help.

All necessary equipment should already be stocked with every bronchoscope stand or tower. Mobilize early assistance, including with anesthesia techs, to ensure essential equipment availability.

Part 3: Put the Aintree in the Trachea

Continue ventilation. Continue oxygenation. 

Use the scope, preloaded with the Aintree, and drive through LMA, vocal cords and down to the carina. Then railroad the Aintree into the trachea. Take care not to advance past the carina.

Part 4: Railroad ETT into trachea

Apneic portion of procedure.

Up until this point, the patient has been continuously oxygenated and ventilated, expanding the safety window for the patient and giving you more time to complete all steps to this point. These next steps will take place during apnea.

One less, one less problem

Hold my coffee: Equipment factors that can make this all go south

Problems & Solutions

The disposable bronchoscopes have inferior textile fidelity, especially with the smaller scopes. Fiberoptic intubations can simply be more frustrating when using this scope.
 
One specific point for failure, however, has occurred despite excellent visualization of the vocal cords. Rarely, even when the procedure is handed over to experienced faculty, there has just been extreme difficulty or eventual failure in advancing the scope through the vocal cords. The cause remains unclear, though it likely has something to do with the flimsy nature of this bronchoscope tip.

For especially concerning or failed airways, request the Olympus tower

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