Can the Ventrain Make Surgical Cricothyrotomy a Thing of the Past?

[@Dookie69uk]

That's a really neat bit of equipment, very useful.

[@lmellick]

It really is!

[@Victoriaghh]

One day I hope to be donated just for medical use. This is an incredible tool.

[@lmellick]

That's very kind and generous of you. Thanks!

[@JoelWelter]

Ideally, it would be great if they could automate the pressures for inhalation and exhalation, so that you meet desired pressures. I would worry about under inflation caused by being a.little slow on putting the thumb back over the control orifice. On another note, it's the prime jazz concert season and we've not seen any bit of some horn action from you. Slowing down or maybe switching to a percussion instrument? Haha!

[@lmellick]

No, no, no, not percussion! Not slowing down but am working on some other projects. For now maybe replay my favorite solo duet with my daughter, Dakota. kzbin.info/www/bejne/hZWuknR4pNCGZqM

[@faisalalmutairii]

love this channel. i have been reading about medicine during the last year of college now almost 10 years already. if i go back in time i would enter emergency medicine but now at 37 it is quite difficult to start medical school given my personal situation although no impossible. all the best dr larry. faisal from kuwait.

[@lmellick]

Thank you for the kind words, Faisal. I wish you the best of luck and encourage you to follow your dreams!

[@euchreairgaming]

What's your opinion on the application of this in the pre-hospital/combat setting. I'm a Navy Corpsman and we learn surgical crics but are told how the rate of failure in the field is 33%. I wonder if this is compatable with a BVM so it can be used without a portable vent or O2 if needed. It seems much simpler and easier to use in high stress and low light situations. It also looks like it can be done faster than a surgical cric and requires less gear, allowing to fit more airways in a medbag. Seems like a no-brainer, but please enlighten me to some of the cons. Is there still significant risk of esophageal perforation? How easily can the 14G be obstructed with blood or sputum? Can I use a manual suction if a powered one is not on hand? Be happy to hear your take on it Dr.

[@lmellick]

Can definitely be used in the prehospital setting or combat situation but not with a BVM, not with a regular 14-gauge catheter (need the Cook TTJV needle) and not without oxygen source.

[@theparaminuteman]

Paramedics would never get access to this, we will likely be stuck with surgical for the indefinite future

[@RescueNurse]

That's most likely what somebody said about the i,o. driller and i.v. at one point...

[@etsout]

Impressive!

[@jamesbridges7750]

I wouldn't say it completely eliminates surgical crics, but refractory obstructions are likely more common than the kind of trauma that would require one.

[@lmellick]

Thanks for your comment and perspective.

[@bs838]

Have you had any experience using this on a patient? If so what was your real-world experience like? Also do you think this is more useful for peds than for adults?

[@lmellick]

I have not used this on a real patient. There are quite a number of reports in the literature describing its successful use if you do a PubMed search. Successful use with both pediatric and adult patients are described (usually in the OR setting). Willemsen MG, Noppens R, Mulder AL, Enk D. Ventilation with the Ventrain through a small lumen catheter in the failed paediatric airway: two case reports. Br J Anaesth. 2014 May;112(5):946-7. doi: 10.1093/bja/aeu125. PMID: 24771793. Wahlen BM, Al-Thani H, El-Menyar A. Ventrain: from theory to practice. Bridging until re-tracheostomy. BMJ Case Rep. 2017 Aug 16;2017:bcr2017220403. doi: 10.1136/bcr-2017-220403. PMID: 28814580; PMCID: PMC5614308. Borg PA, Hamaekers AE, Lacko M, Jansen J, Enk D. Ventrain® for ventilation of the lungs. Br J Anaesth. 2012 Nov;109(5):833-4. doi: 10.1093/bja/aes366. PMID: 23066007.

[@colinnash4055]

As a pre-hospital provider, what are your thoughts on this in the pre-hospital setting: Use the traditional 14g IV catheter with a three way stopcock attached at the catheter hub. Place the tube in a 20cc syringe directly inline with the IV catheter. In addition on the lateral side of the stopcock place a 60cc syringe. Could that be used create a "push-pull" method by using artificial inspiration with the BVM and artificial exhalation by pulling back on the 60cc syringe? Just thinking about using the toolbox I have to avoid a "one way trip" for the O2 as we currently would do with a needle cric in a pediatric.

[@lmellick]

Interesting thought. However, the ability to ventilate with this device has been demonstrated in the OR setting. This system is so much simpler and isn't all that expensive.

[@jdog370]

What is the O2 flow rate? It seems like a lot of o2 is used for this, making it less practical than a regular cric that doesn’t require high pressure o2 pressure hospitally also, have studies been conducted looking at co2 retention profiles for this device? Regular TTJV is not used for long times because of co2 issues.

[@lmellick]

It's not that much oxygen and obviously is working differently from the cricothyrotomy. I attached some references to someone in this comments section. Nevertheless, look up the Ventrain in PubMed and there are a number of articles describing how it works and successful cases (mostly in the OR). Also, go to the Ventrain web page for more information. I hope this helps. ventinovamedical.com/ventrain/

[@Victoriaghh]

Incredible.

[@beauxtx1959]

NICE!

[@lmellick]

Thanks!

[@vishwarao6064]

is that a dead body?

[@lmellick]

Yes

[@Fatty-Elektra]

HOW