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The Tulip airway is a range of airway devices designed to allow anyone to resuscitate anybody anywhere, even by family members and children at home. The Tulip has been specifically created for both inexperienced and experienced users to allow life saving intervention in even semi-conscious patients. The Tulip is a direct replacement for the Guedel and Facemask and is the first airway designed for both hospital and home use. It may be used for Basic Life Support (BLS) or any airway requirements including starved elective anaesthesia cases. It is the smallest, softest, least invasive and least stimulating airway allowing hands-free, directly connectable ventilation for provision of life support. The Tulip is available as the multi-sized Tulip GT both with and without a headband and as the one-size Tulip Rainbow and Tulip Advance.
Airway management is usually conducted by medical professionals but most collapses and cardiac arrests happen outside the hospital and at home. No assistance is likely to arrive within the 3-5 minutes we have to save the patient so everyone must be able to manage an airway and conduct BLS CPR (Basic Life Support Cardio Pulmonary Resuscitation) at home or the patient will die. The Tulip is the first airway device designed for this and as such the Tulip may also be easily used by medical professionals in the hospital in A+E/ER, on the Wards, by Paramedics in Ambulances and for complex uses such as starved elective anaesthesia. The Tulip is the first airway designed for everyone.
Why The Tulip?
The single objective of the Tulip airway is to replace the antique and outdated Guedel airway worldwide.
The Guedel airway was invented in 1933, it is an outdated, obsolete antique and is the hardest airway to use for non anaesthetic staff, medical and non-medical, in hospital and outside it, yet the least experienced BLS (Basic Life Support) airway providers have to use it because no alternatives have been available, until the arrival of the Tulip Advance (one size fits all adults) and Tulip GT (Guedel Type). This is because the Guedel is small and can be used to support airway requirements in semi-conscious patients, which cannot be done with LMA’s or iGEL devices due to physical size and the high level of reflex stimulation they cause when positioned.
The LMA and iGEL devices sit much deeper than the Guedel or Tulip so cause reflex coughing, gagging and vomiting in semi-conscious patients and cannot be used, leaving only the Guedel suitable for the role until the Tulips arrived. The Tulips cause minimal stimulation and can also be used in semi-conscious patients as multiple patients have been witnessed waking and talking through the airway tube of a Tulip with the fully inflated Tulip still in-situ still providing an airway. The Tulips allow fully awake self-extubation, such is the low level of stimulation, which is a significant safety benefit in addition to ease of use, user preference, lower cuff pressures, lower ventilation pressures, higher tidal volumes, higher oxygen concentrations provided to the patient and the multiple performance and the hands-free, directly-connectable benefits which reduce manpower requirements and the over all time spent by the patient in the Operating Theatre and Recovery Suite.
The Guedel is not directly connectable, requires 2 – 3 hands and 1 – 2 operators for competent use as it requires facemask skills which are hard and provides diluted oxygen with uncontrolled ventilation pressures at times of absolute emergency. Failure rates are very high for inexperienced BLS airway providers as it is largely an Anaesthetic Doctors skill at the moment as even other Doctors usually perform poorly.
The worst airway is used first when it is a matter of life and death yet the Guedel airway is the single largest selling and most widely used airway in the world. This must change because the deterioration caused by this inefficient airway reduces survival and increases neurological deficits.
The Tulip GT does not just make the impossible possible, it makes the impossible easy.
In simple terms the Guedel airway doesn’t work, even with non-anaesthetic Doctors, but is relied upon by Paramedics, Nurses, Police, Ambulance, Aviation, Shipping…etc. and yet remains the first line airway intervention in most airway cases world-wide. The Tulip GT is for everyone, including and especially inexperienced users and specifically for domestic homes. It is possible for an 8 year old to resuscitate an adult at home with a Tulip, such is the difference between a Guedel/Mask and a Tulip GT. This change is absolutely required for patient safety and for updating antique obsolete equipment for which no previous alternative has existed.
The Guedel figures and reputation is so poor that this objective will be relatively easy, as the Tulip GT is hands-free and directly-connectable allowing significant improvements in safety, oxygen provision, airway management and functional performance with increased tidal volume breaths being achieved using less ventilating pressure, further reducing risk. No one has ever tried to replace the Guedel before and once the Tulip GT does, no further replacements will be required.
The intention is to increase the appallingly poor Out Of Hospital Cardio Pulmonary Resuscitation (OOH CPR) survival rates which are approximately 1.25 – 2.5% for survival without neurological consequences. Such statistics equate to certain death if someone has an out of hospital cardiac arrest but when no one can actually do ABC (Airway Breathing Circulation) it is no wonder. The Tulip allows anyone, anywhere to perform competent CPR on anyone, anywhere and at any time including you in your own home on someone you love who needs it because if you don’t, they will die. No ambulance can get there in 3 minutes and 30 seconds so this must happen and you must do it because in a better world, this would be the way of things.
The Tulip GT is designed to work effectively anywhere but that includes Operating Theatres where it is expected to deliver unto 90% of starved elective anaesthetics eventually. The Tulip GT will replace the Guedel on the Wards, in Accident +Emergency/ER, in Ambulances and in all Resuscitation kits worldwide.
The Tulip range has a number of devices, a number of advantages and a number of roles but all of these will become apparent if we focus on and achieve only one thing – replace the Guedel airway world-wide.
The Tulip is the smallest directly connectable, hands-free airway and as such it is the least stimulating meaning that the patient may be semi-conscious on insertion and may also self-extubate when awake without gagging or vomiting as occurs with other directly connectable airways.
The Tulip GT is a replacement for the Guedel and Facemask so is multi-sized and coloured like Guedel airways to assist familiarity for inexperienced users with a clear insertion depth and a headband for self-retention.
Both the Tulip Rainbow and Tulip Advance are one-size-fits-all-adults alternatives for the Laryngeal Mask and iGEL being insert to fit and inflated to fit according to colour markings for small/medium/large sizes. The Tulip Rainbow has a round cross-section breathing tube that is flexible whilst the Tulip Advance has a rigid oval cross-section breathing tube with a larger internal diameter.
The Tulip GT is a direct replacement for the Guedel and Facemask and is for all users. Clinical trials have shown statistically significant results with the inexperienced user generated 77% bigger tidal volumes, 101% higher end-tidal CO2 readings and 36% higher ventilation pressures with the Tulip GT® airway when comparing the Tulip GT® airway to the Guedel airway with facemask ventilation (p <0.0001).
Adequate ventilation was achieved in 60 out of 60 users (100%) with the Tulip GT® airway and in 48 out of 60 users (80%) with the Guedel/Facemask ventilation. The end-tidal CO2 and tidal volume outcomes were achieved in 56 of the 60 (93%) users with the Tulip GT® airway and in 16 of the 60 users (27%) with the Guedel/facemask airway (p < 0.001). 10 of the 60 users (17%) failed to ventilate the patient at all using the Guedel and Facemask technique.