MEA Indications for Use and Insertion Technique
Introduction: The McMurray Enhanced Airway (MEA) is the first distal pharyngeal airway (DPA). The MEA is indicated for oral use to relieve upper airway obstruction, to provide apneic oxygenation during intubation, or to provide intraoral ventilation with assistance during difficult mask ventilation. It is a simple but effective option for opening the airway quickly to reduce hypoxia during anesthesia or emergencies to improve patient safety and outcomes. The DPA is disposable and designed for single use. The MEA is free of latex, DEHP, BPA, and PVC materials. The MEA is non-sterile. It can be utilized in inpatient or outpatient surgery, in hospital or clinic settings, or in an emergency setting.
MEA Design: The MEA has five parts (as pictured below): an optional 15 mm connector, flange (color-coded for size), elongated cushioned bite block, flexible cannula, and distal tip.
MEA Indications for Use: The MEA is indicated for use to relieve upper airway obstruction, facilitate apneic oxygenation, or to provide intraoral ventilation with assistance .
The MEA is intended to be used for the following scenarios:
Anesthesia and Emergency Adjunct:
MEA without MEA connector - To open and maintain a patent airway by separating the tongue and soft palate from the posterior wall of the oropharynx during upper airway obstruction.
MEA with MEA connector - To deliver apneic or passive oxygenation during intubation by placing the MEA on left side of mouth and attaching to anesthesia circuit or bag valve mask (BVM) while intubating around the MEA.
MEA with MEA connector - To facilitate positive pressure intraoral ventilation during routine ordifficult mask ventilation by attaching the MEA and MEA 15 mm connector to the anesthesia circuit or BVM while manually closing the patient’s mouth and nares. Or use a straight connector attached to MEA, placing it through mask’s hole and connecting the ventilation device.
MEA with or without MEA connector – To prevent collapsing of a laryngeal mask airway (LMA) or endotracheal tube (ETT) by placing the MEA bite block between the molars.
MEA with or without MEA connector – To open the upper airway obstruction during EGD. The MEA fits alongside the EGD bite block.
MEA with MEA connector - To decrease fire risk by reducing oxygen diffusion around the surgical field by attaching the MEA and MEA 15 mm connector to the anesthesia circuit while maintaining appropriate total liter flow and FiO2.
MEA Contraindications for Use: The MEA is contraindicated in a patient who is conscious, responsive to verbal stimuli or chin lift, and/or has an intact gag and/or cough reflex. If vomit, blood, foreign body, or excessive sputum is obstructing the airway, the MEA should not be used until the patient’s airway has been cleared. The MEA should not be used for longer than 24 hours without replacement.
Insertion Technique Instructions:
1. Consider indications and contraindications for use.
2. Choose the appropriate MEA size. The distal tip of the MEA should sit slightly above the epiglottis. To accomplish this, the MEA should measure approximately the distance between the philtrum and the tip of the earlobe (as pictured below). The MEA size 4 is suitable for most patients approximately 5 ft-6 ft in height.
3. Once the patient is unconscious, unresponsive to verbal stimuli and chin lift, and has a negative gag and/or cough reflex, open the patient’s mouth by pulling chin down. Suction airway as needed.
4. With the curved end facing the hard palate, gently place the MEA in the mouth. Guide the MEA straight back over the tongue toward the pharynx. No lubricant or tongue depressor is needed. Place MEA bite block between the molars to minimize movement, gagging, and dental damage. The MEA depth can be fine-tuned by adjusting the placement depth of the elongated bite block. The flange should rest gently outside the corner of patient’s lips.
5. Confirm appropriate sizing and placement by observing rise and fall of chest, auscultating breath sounds, and monitoring EtCO2 and oxygen saturation.
Store device in primary sealed package.
Single use: Device is not to be reused – patient infection may result from reuse.
Do not use if primary package seal is broken or device has previously been removed from primary packaging.
If the MEA is too long: Unintentional placement within the esophagus, vallecula, or trachea may lead to vomiting, gastric distention, aspiration, hypoxia, laryngospasm, and/or airway obstruction.
If the MEA is too short: Failure to maintain a patent airway.
During insertion: Damage to lips, oral structures, and/or teeth. As with all airways, it is important to assess dentition prior to use and inform patient that there is a risk of dental damage. If loose teeth are present, minimize potential aspiration risk.
During removal: Damage to teeth, jaw, and/or MEA structure. To avoid this, ensure the patient’s bite has been released prior to removal.
When using connector attachment: If the connector is not fully seated in the MEA and tight, this could lead to excessive oxygen leakage, thereby increasing hypoxia and the fire risk. To minimize the fire risk, keep inspiratory FiO2 < 30% and minimize oxygen/air flow when possible.
Philtrum to tip of the earlobe