McMurray Enhanced Airway Can Reduce Certain Patient-Provider Contact
St. Paul, Minn. — June 3, 2020 — A new airway management device, the McMurray Enhanced Airway (MEA), maintains a patent airway without the need for healthcare staff to hold the patient’s head in positions that keep the airway open—physical contact that often occurs for the duration of a procedure and again in the post-anesthesia care unit (PACU).
“Chin lift and jaw thrust maneuvers are commonly used by anesthesia and nursing staff to keep anesthetized patients’ airways open during and after surgical procedures. These practices require direct contact between the patient and provider, sometimes for extended periods,” said Roxanne McMurray, DNP, APRN, CRNA, and inventor of the MEA. “The MEA helps reduce the need for hands-on chin lift and jaw thrust positions in both the OR and PACU, which takes on new importance in the COVID-19 era.”
The distal end of the MEA’s longer flexible tubing sits lower in the pharynx than other oral airways. The MEA displaces redundant pharyngeal tissue within the upper airway near the epiglottis, stenting open the airway for improved ventilation without the need for jaw thrust and chin lift. In addition to requiring patient-provider contact, these maneuvers can lead to clinician fatigue and discomfort and post-procedure jaw pain for patients.
Current CDC guidance states that COVID transmission risks can occur “between people who are in close contact with one another (within about 6 feet)” and also “through respiratory droplets produced when an infected person coughs, sneezes, or talks”(1). Health care providers use personal protective equipment, but facilities still may find value in other measures to mitigate particle exposure. The MEA, for example, can help limit exposure to aerosolized particles when it is attached to the anesthesia circuit via its connector.
Using the MEA to bridge deep extubation or LMA removal after general anesthesia may also help lessen patient coughing. “Deep extubation is not always an option due to contraindications and the time and technical finesse it requires; however, it typically results in less patient coughing than extubating an awake patient,” said McMurray.” Preliminary results from a 34-patient study in an outpatient surgery center found that placing the MEA after deep extubation in the OR and before transfer to recovery led to less patient coughing and diminished the need for a chin lift or jaw thrust in PACU (2).
Though COVID was not a consideration when the MEA was developed, McMurray did factor in clinical need, ease of use and patient safety. The MEA was created to address a lack of airway tools that work well for deep sedation or deep monitored anesthesia care (MAC) cases. Because traditional oral airways cannot always adequately displace redundant pharyngeal tissue, anesthesia providers have applied workarounds to improve ventilation. A newly published paper found that more than half of the 293 U.S. nurse anesthetists surveyed on airway management practices had used nasal airways orally (3) — an off-label practice. Reasons cited included improving airway patency and reducing jaw thrust and chin lift maneuvers, especially with patients who are obese, elderly and/or who have history of obstructive sleep apnea.
The MEA’s pliable tubing aids in easy insertion while a built-in bite block is designed to prohibit the patient from biting down and compressing or severing the airway tubing—risks associated with the oral use of nasal airways. An integrated flange decreases the risk of the airway becoming dislodged at the lips. Nearly all of the survey respondents (98.2%) indicated they would be interested in trying a novel airway device similar in structure to a nasal airway but designed for oral use (3).
In late 2019, McMurray Medical was selected as a finalist for the World Airway Management Meeting (WAMM) Innovation in Airway Management award, which recognizes “the importance of innovation in Airway Management for the benefit of patients, staff or workplace or any combination of the three,” according to WAMM.
Visit mcmurraymed.com for more information.
McMurray Medical was founded by Roxanne McMurray, DNP, APRN, CRNA, Assistant Clinical Professor for Nurse Anesthesia Specialty at the University of Minnesota School of Nursing and a practicing anesthesia provider for more than 25 years. Motivated to find a safe, cost-effective, easy, and fast way to open the obstructive airway, the McMurray Enhanced Airway (MEA) was created.
1 Centers for Disease Control and Prevention CDC). Coronavirus Disease 2019 (COVID-19)—Prevent Getting Sick — How COVID-19 Spreads. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/how-covid-spreads.html. Accessed May 13, 2020.
2. Daniel C, Gordon L, Feeney M. A Comparison in Efficacy of the McMurray Enhanced Airway in Alleviating Obstruction in Adults During Deep Sedation and Post Deep Extubation. Manuscript in preparation..
3. McMurray R, Becker L, Frost Olsen K, McMurray M. Airway Management for Deep Sedation: Current Practice, Limitations, and Needs as Identified by Clinical Observation and Survey Results. AANA J. 2020;88(2):123-129.
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