The pharyngeo-tracheal lumen airway: preliminary investigation of a new adjunct.

The technique of prehospital airway management is determined largely by the level of training and expertise of the prehospital care provider. We report preliminary observations and data in experimental animals and patients using a new airway adjunct--the pharyngeo-tracheal lumen (PTL) airway. The PTL airway employs a two-tube, two-cuff system that is inserted in a "blind" fashion. The airway's design allows it to function as an endotracheal tube if the trachea is entered or as an esophageal obturator airway (EOA) if the esophagus is intubated. In the esophageal position, a face-to-mask seal is not required. Preliminary data in 23 experimental animals suggest that the PTL (in the esophageal position) is as effective as a conventional cuffed endotracheal tube. Volumetric efficiency at optimal cuff inflation pressures was 100%, and arterial blood gas values obtained during PTL ventilation were not significantly different from those measured during ventilation with an endotracheal tube at comparable minute ventilations. In six arrest patients undergoing cardiopulmonary resuscitation, arterial PO2 and PCO2 using the PTL airway (176 +/- 105 mm Hg and 36 +/- 12 mm Hg, respectively) were not significantly different from those measured during artificial ventilation with an endotracheal tube (PO2, 162 +/- 124 mm Hg; PCO2, 34 +/- 10 mm Hg). Although the numbers are small, the data suggest that the PTL airway may be an alternative method of emergency airway management when endotracheal intubation cannot be performed.