MEA Indications for Use and Insertion Technique
Introduction: The McMurray Enhanced Airway (MEA) is an easy-to-use flexible distal pharyngeal airway (DPA) designed to open and maintain a patient’s upper airway, facilitate spontaneous or intraoral manual ventilation, promote oxygenation, and improve safety. It 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, and a channel to allow for passage of air and a suction catheter.
Indications for Use: The MEA is indicated for oral use as a distal pharyngeal airway to relieve upper airway obstruction or to provide intraoral ventilation with assistance.
The MEA is intended to be used for the following scenarios:
> Deep Unconsciousness/Sedation/MAC Anesthesia:
MEA without MEA connector - To open and maintain a patent airway by separating the tongue and soft palate from the posterior wall of the distal pharynx.
MEA with MEA connector - To decrease fire risk by reducing oxygen diffusion around the surgical field. This is accomplished by attaching the MEA and MEA 15 mm connector to the anesthesia circuit while maintaining appropriate total liter flow and FiO2.
> General Anesthesia:
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 MEA connector - To facilitate positive pressure intraoral ventilation during routine or difficult mask ventilation. This is accomplished by attaching the MEA and MEA 15 mm connector to the anesthesia circuit while manually closing the patient’s mouth and nares.
> Emergency Adjunct:
MEA with MEA connector - To facilitate positive pressure intraoral ventilation in an emergency setting. This is accomplished by attaching the MEA and MEA 15 mm connector to a manual resuscitator bag, while manually closing the patient’s mouth and nares.
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 depth can be fine-tuned by adjusting the placement of the bite block. The MEA size 4 (yellow flange) corresponds to the patient population that would typically use a size 9, 90 mm, yellow oral airway.
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 posterior pharynx. No lubricant or tongue depressor typically required. The MEA bite block can be placed between the molars to minimize movement. The MEA depth can be fine-tuned by adjusting the placement of the bite block between the teeth. The flange should rest gently outside the 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 airway, this could lead to excessive oxygen leakage, thereby increasing the fire risk. To minimize the fire risk, keep inspiratory FiO2 < 30%, open APL valve and minimize oxygen/airflow when possible to keep appropriate tension on the reservoir bag.
Philtrum to tip of the earlobe