Abstract
Ventilated post-mortem computed tomography (VPMCT) has been shown to achieve lung expansion in cadavers and has been proposed to enhance the diagnosis of lung pathology. Two key problems of the method of ventilation have been identified: firstly, the presence of head and neck rigor making airway insertion challenging and, secondly, air leak, if there is not a good seal around the airway, which diminishes lung expansion and causes inflation of the stomach. Simple procedures to insert a ‘definitive’ cuffed airway, which has a balloon inflated within the trachea, are therefore desirable. This study aims to test different procedures for inserting cuffed airways in cadavers and compare their ventilation efficacy and to propose a decision algorithm to select the most appropriate method. We prospectively tested variations on two ways of inserting a cuffed airway into the trachea: firstly, using an endotracheal tube (ET) approach, either blind or by direct visualisation, and, secondly, using a tracheostomy incision, either using a standard tracheostomy tube or shortened ET tube. We compare these approaches with a retrospective analysis of a previously reported series using supraglottic airways. All techniques, except ‘blind’ insertion of ET tubes, were possible with adequate placement of the airway in most cases. However, achieving both adequate insertion and a complete tracheal seal was better for definitive airways with 56 successful cases from 59 (95 %), compared with 9 cases from 18 (50 %) using supraglottic airways (p < 0.0001). Good lung expansion was achieved using all techniques if the airway was adequately positioned and achieved a good seal, and there was no significant chest pathology. We prefer inserting a shortened ET tube via a tracheostomy incision, as we find this the easiest technique to perform and train. Based on our experience, we have developed a decision algorithm to select the most appropriate method for VPMCT.
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Acknowledgments
We wish to thank the relatives who gave consent for their recently departed loved ones to be part of this study. We also wish to thank H.M. Coroners’ offices for North and South Leicestershire for their support of this project, our study co-ordinator T. Visser and all the radiology and mortuary staff who supported this project.
This article presents independent research funded by the Home Office Science Secretariat, Science Group. The views expressed in this publication are those of the author(s) and not necessarily those of the Home Office.
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G. N. Rutty and B. Morgan contributed equally to this work.
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Rutty, G.N., Biggs, M.J.P., Brough, A. et al. Ventilated post-mortem computed tomography through the use of a definitive airway. Int J Legal Med 129, 325–334 (2015). https://doi.org/10.1007/s00414-014-1135-5
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DOI: https://doi.org/10.1007/s00414-014-1135-5