Note: Descriptions are shown in the official language in which they were submitted.
7~3868
ESOPHAGEAL-ENDOTRACHEAL AIRWAY
An early airway for assisting in artificial respira-
tion was made of an arcuate, open-ended tube which was
adapted to be inserted into the trachea. This tube carried
an external, inflatable, resilient sleeve near its distal
end. The sleeve, when inflated, made a seal with the inner
wall of the trachea.
Moving air through the trachea into and out of the
respiratory orifices with this early airway required trained
personnel, such as is normally found in hospital emergency
rooms.
In U.S. Patents Nos. 3,683,908 and 3,841,319 is
described an airway whose tube has a closed distal end. A
plurality of openings are provided in the wall of the tube
between its distal and proximal ends. The proximal end is
the mouthpiece of the airway. The tube is shaped to become
inserted into the esophagus which leads to the stomach. The
tube carries near its distal end an inflatable sleeve. The
slee~e, when inflated, can make a seal with the esophagus.
~orced air passes from the inside to the outside of the tube
through its openings and into the lungs of the patient. A
mask is used to prevent the forced air from escapin~ through
the patient's nose and mouth and to force the air to flow
into the lungs
But, if this close-ended tube of the airway were to
be accidentally inserted into the trachea, as it ma~ occa-
sionally happen, the inflatable sleeve would seal off the
trachea and the pumped air would flow into and inflate the
stomach instead of the lungs. When depriving the lungs of
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air, the patient may die. Also, inflating the stomach may
result in vomiting which alerts the attendant that the
tubular member is in the trachea. The attendant will
attempt to deflate the sleeve, remove the tube from the
trachea, and insert it into the esophagus. sut, even if
this rescue operation is timely and successful, the vomiting
from the patient's stomach can penetrate into the lungs and
the patient may become seriously hurt or even die.
Also, when the tube is in the esophagus, the required
mask for the nose and mouth may not provide an effective
seal with the patient's face because face dimensions vary
with every patient.
A problem can be also encountered even when the tube
is inserted into the esophagus. If vomiting occurs during
resuscitation, then high pressures become exerted from the
stomach up through the esophagus. If the tube is in the
esophagus with its sleeve inflated, vomitus cannot exit.
Excessive pressure then becomes exerted at the junction zone
between the stomach and esophagus. This high pressure can
tear the esophagus away from the stomach which results in
severe hemorrhaging.
Other airways are described in U.S. Patents Nos.
3,322,126, 3,788,326, 3,905,361, 4,090,518, 4,231,365 and
East German Patent No. 68,597.
The novel airway of this invention comprises an
elongated inner tube which is mounted inside a shorter outer
tube. Both tubes form a passageway therebetween. On the
outer ~all near the distal end of each tubular member is
disposed an inflatable sleeve. The inner tube extends
through the wall of the outer tube near the proximal end of
the outer tube. The proximal end of each tube is adapted
to accept an air pump. Suction tubes can be inserted either
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through the inner tube or through the passageway formed
between the walls of the tubes for pumping out the contents
of the stomach or the lungs.
Broadly speaking, therefore, the present invention
may be considered as providing an esophageal-endotracheal,
flexible, tubular airway device adapted for insertion through
the mouth, in normal use, into the esophagus and, in
abnormal use, into the trachea of a patient, the device being
adapted to provide separate passages for administering
artificial respiration both when the device is lodged in the
esophagus or in the trachea, the device comprising (a) a
larger-diameter, shorter flexible tube having an open-ended
proximal end portion and an open-ended distal end portion;
~b) a smaller-diameter, longer flexible tube having an open-
ended proximal end portion and an open-ended distal end
portion, the longer tube being disposed inside the shorter
tube whereby the outer wall of the longer tube and the inner
wall of the shorter tube define therebetween an annular fluid
passageway wherein a suction tube could be extended through
the passageway into the trachea or the esophagus ~~or
evacuating fluid contents therefrom while administering
artificial respiration to the lungs, the annular passageway
having an open outlet port at the distal end portion of the
shorter tube, and the longer tube having a suficient length
adapted, in use, to reach into the esophagus below the mouth
of the trachea, and the port of the annular passageway to
become disposed above the mouth of the trachea; (c) an
inflatablé-and-deflatable tubular balloon extending about and
sealed to the distal end portion of the longer tube for
sealingly engaging, in normal use, upon inflation thereof the
wall of the esophagus below the mouth of the trachea and upon
abnormal use, for sealingly engaging the wall of the trachea,
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and (d) an inflatable-and-deflatable tubular balloon extending about and
sealed to the distal end portion of the shorter tube for simultaneously
sealing off, in normal use, upon inflation thereof, the air passageways
leading to the nose and to the m~outh of the patient, thereby allowing,
in normal use, with the twD balloons inflated, air to flow through the
annular passageway into the patient's lungs.
~ ays of carrying out the invention are described with reference
to the drawings which illustrate specific preferred embcdiments and in which:
Fig. 1 is a perspective view of the novel double-tuke ai~way of
the present invention;
Fig. 2 is a transverse sectional view taken on line 2-2 of Fig. l;
Fig. 3 is an enlarged, longitudinal, sectional view of a portion
of the airway near the junction between both tukes;
Fiqs 4 and 5 are fraamentary sectional views showing the air
channels leading to the sleeves carried by the inner and outer tubes,
respectively;
Fig. 6 shows the novel airway with its inner tube accidentally
lodged in the trachea;
Fig. 7 shows the novel airway with its inner tube in the trachea
for a~inistering artificial resuscitation and carrying a suction tube for
simultaneously suctioning the patient's stomach;
Fig. 8 shows the novel airway in its normal use while administer-
ing artificial resuscitation with its inner tubs in the esophagus and both
sleeves of the airway being inflated;
Fig. 9 is similar to Fig. 8 and in addition the airway ries
a suction tube for suctioning the patient's lungs;
Fig. 10 is similar to Fig. 9 except that the stornach is now
being suctioned;
Fig. 11 is similar to Fig. 8 except that vomitus is expelled to
the atmosphere thereby preventin~ a dan~erous pressure build up;
.
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li7~386~3
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Fig. 12 is similar to Fig. 8 except that the proximal
sleeve on the outer tube is deflated and a mask is used
instead to cover the nose and mouth; and
Fig. 13 is similar to Fig. 2 but showing the airway's
tubes as being eccentric.
Figs. 1-5 show the novel esophageal-endotracheal air-
way of the present inventionj generally designated as 10.
It includes an inner, elongated, flexible tube 11 having a
longitudinal bore B whose distal end 12 (Fig. 1~ is open.
An outer, shorter flexible tube 9 is concentrically mounted
with the inner tube 11 (~ig. 2). The concentricity between
tubes 9, 11 is maintained by radial ribs 13. The distal end
9a of tube 9 is also open. Both'tubes 9, 11 define an
annular passageway 9b therebetween.
An expandable member, such as an inflatable sleeve
15a, is mounted externally near the distal'end 12 on inner
tube 11. ~nother inflatable sleeve 15b is mounted on tube
9 near its distal end 9a. Small-diameter hoses 14a and 14b
are adapted to carry pressurized air for inflating sleeves
15a and 15b, respectively. Each hose 14a or 14b is coupled
to a check valYe 16 (Fig. i). When slee~es 15a, 15b expand,
- as represented by the dotted lines, they form effective
seals with the adiacent surrounding wall of the body channel.
~s will be subsequently described, the novel airway 10 can
seal o~f the nose and mouth without the assistance of a
facial mask.
The inner tube 11 extends through an opening 9c (~ig.
3) in the wall of the outer tsbe 9 near its proximal end 9d.
Tubes 9 and 11 form a fluid-tight joint 9f therebetween.
The proximal ends'9d and lld of the tubes 9 and 11 are
coupled to adapters 19 and 18, respectively. ~ach adapter`
can recei~e the outlet of a con~entional air pump 17 (Figs.
- 6-12~. Tube 11 has'a'hole 8 therethrough in a direction
perpendicular to its longitudinal axis in order to make its
distal end 12 more flexible.
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In use, when inner tube 11 by accident becomes
inserted into the trachea (Fig. 6~, the attendant need only
inflate sleeve 15a. Resuscitation with pump 17 can be
produced through bore B (Fig. 2~ of tube 11.
Fig. 7 shows that while resuscitation is being
administered to the patient, the contents of the stomach can
be emptied by inserting into the esophagus, through the
annular passageway 9b, a suction tube 21 suitably coupled to
a conventional suction pump (not shown~.
Fig. 8 shows the normal position of airway 10 for
administering artificial resuscitation. Tube 11 is inserted
into the esophagus. Both sleeves 15a, 15b are inflated.
Air is pumped by pump 17 into tube 9. This ~orced air
` passes from the distal end 9a of outer tube 9 through the
trachea and into the lungs.
Fig. 9 is similar to Fig. 8 e~cept that a suction
tube 21 is now inserted through a T-coupling member 22 into
tube 9 and exits from its distal end 9a into the trachea o~
the patient. The T-coupling 22 has a packing gland 23. In
this manner, artificial resuscitation takes place simultan-
eously with the suctioning of the lungs.
As an immediate advantage of the novel airway 10~
even when the inner tube 11 by accident becomes inserted
into the trachea ~Fig. ~, the respiratory function of the
airway can still be carried out, and in addition, the contents
of the lungs and the contents of the stomach (Fig. 7) can be
suctioned out. Also, during normal use of the airway (Fig.
8?, artificial respiration can be maintained, while the
contents of the lungs (Fig. 9) or the contents of the
stomach (Fig. 10~ are being suctioned out.
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Fig. 11 is similar to Fig. 8 except that regurgita-
tion has taken place already with vomitus pouring out from
the proximal end of the inner tube 11. sut this vomitus
neither produces contamination o~ the posterior pharynx nor
increases the pressure at the junction between the stomach
~ and the esophagus.
Instead of inflating sleeve 15b as in Fig. 8, a mask
29 (Fig. 12) can be employed. No excessive pressure will
then develop at the union between the stomach and the
esophagus during Yomiting, because bore B (Fig. 2) of tube
11 remains open to the atmosphere while tube 11 is being
inserted into the esophagus.
When sleeve 15a is inflated it creates a seal against
the esophageal wall and yomitus cannot contaminate the
posterior pharynx.
In Fig. 13 is shown a modification of the airway
structure wherein the same numerals followed by a prime (')
are used to designate the same or similar members. Each
thusly designated member serves a function as previously
descrihed. It will be noted that tubes 9' and 11' are
not concentrically mounted. In fact, the tubes can have
their walls in touching relation as shown.
