2. Department of Anesthesiology and Pain Medicine, University of Washington-Harborview Medical Center, Seattle, WA, USA.
The laryngeal tube is increasingly being used for prehospital airway rescue. However, its exchange for an endotracheal tube can be challenging and risky. No best technique to achieve this end is yet accepted. We report three trauma cases where a fiberoptic, wire-guided, laryngeal tube-to-endotracheal tube exchange using the Arndt Exchange Catheter Set was performed. Three patients with multiple traumatic injuries presented to the emergency department with a laryngeal tube, with or without a gastric port, in place. All were in cervical stabilization collars. One had blood and gastric contents filling the ventilation tube and gastric port, respectively. One was undergoing cardiopulmonary resuscitation. In all cases, a fiberoptic bronchoscope and an Arndt Exchange Catheter Set were used to successfully exchange the laryngeal tube for an endotracheal tube without loss of airway control. In each case, the technique allowed continuous ventilation and oxygenation of the patient nearly throughout the entire exchange process. In conclusion, fiberoptic, wire-guided airway management using the Arndt Exchange Catheter Set can be successfully used to exchange the laryngeal tube for an endotracheal tube in trauma patients and provides a technique that maintains relative airway control throughout the entire exchange procedure, while providing nearly continuous ventilation and oxygenation.
Key words: laryngeal tube, wire-guided, exchange