New use of a tracheal tube for rescue breathing in laryngectomees in the community

Abstract

The currently recommended method for rescue breathing in people who have had a laryngectomy is mouth-to-stoma. Even if they know what to do, by-standers are likely to find this technique unhygienic and therefore unacceptable. There is no equivalent of the pocket face mask for laryngectomees. This paper describes the practical differences that affect rescue breathing in patients with laryngectomy stomas and proposes a new use of a tracheal tube for rescue breathing in laryngectomees. Ten patients with permanent tracheal stomas scheduled for ENT surgery were ventilated successfully through a tracheal tube with the cuff applied to the outside of their tracheal stomas, following induction of anaesthesia and before the start of surgery. Observations of oxygen saturation, end-tidal carbon dioxide, expired tidal volume and chest movements were within acceptable limits. This device was simple to use and is hygienic and inexpensive. Laryngectomees' relatives, friends or carers with minimal training could use the tube in a mouth-to-tube-to-stoma technique should the need for rescue breathing arise. It could also be used by paramedic and medical staff in a mouth or bag-to-tube-to-stoma technique until a definitive airway can be inserted.