Patent Publication Number: US-2005139220-A1

Title: Method and apparatus for ventilation / oxygenation during guided insertion of an endotracheal tube

Description:
RELATED APPLICATIONS  
      The present application is a continuation-in-part of the Applicant&#39;s co-pending U.S. patent application Ser. No. 10/115,224, filed on Apr. 2, 2002, which is a continuation-in-part of U.S. patent application Ser. No. 09/767,272, filed on Jan. 22, 2001, now U.S. Pat. No. 6,568,388, issued on May 27, 2003, which is a continuation-in-part of U.S. patent application Ser. No. 09/707,350, filed on Nov. 6, 2000, now U.S. Pat. No. 6,543,446, issued on Apr. 8, 2003, which is a continuation-in-part of U.S. patent application Ser. No. 09/411,610, filed on Oct. 1, 1999, now U.S. Pat. No. 6,405,725, issued on Jun. 18, 2002, which is a continuation-in-part of U.S. patent application Ser. No. 08/974,864, filed on Nov. 20, 1997, now U.S. Pat. No. 5,964,217, issued on Oct. 12, 1999, which is a continuation of U.S. patent application Ser. No. 08/607,332, filed on Feb. 26, 1996, now U.S. Pat. No. 5,694,929, issued on Dec. 9, 1997. U.S. patent application Ser. No. 10/115,224 (cited above) is also a continuation-in-part of U.S. patent application Ser. No. 09/908,380, filed on Jul. 18, 2001, now U.S. Pat. No. 6,668,821, issued on Dec. 30, 2003, which is a continuation-in-part of U.S. patent application Ser. No. 09/840,194, filed on Apr. 23, 2001, now U.S. Pat. No. 6,634,354, issued on Oct. 21, 2003, which is based in part on, and claims priority to U.S. Provisional Patent Application Ser: No. 60/252,347, filed on Nov. 20, 2000. 
    
    
     BACKGROUND OF THE INVENTION  
      1. Field of the Invention.  
      The present invention relates generally to the field of respiratory devices and methods. More specifically, the present invention discloses a method and apparatus for guiding insertion of an endotracheal tube while the patient continues to receive cardiopulmonary resuscitation in the form of artificial ventilation and cardiac compressions.  
      2. Statement of the Problem.  
      In emergency situations involving cardiopulmonary patients or other patients with compromised or arrested breathing, an oral airway is first inserted into the patient&#39;s mouth. A face mask is then placed over the patient&#39;s mouth and nose. The face mask is connected to an inflatable bag to maintain at least minimal oxygen flow to the lungs in the short term. This particular process of artificial ventilation is sometimes referred to as “bagging” the patient. It is suitable for initially stabilizing the patient. In order to breathe more effectively for the patient during cardiopulmonary resuscitation, and to prevent aspiration of stomach contents, an endotracheal tube (or ET tube) is placed into the trachea. Longer-term care usually requires continued artificial ventilation and attaching the patient to a ventilator (e.g., by means of the endotracheal tube). The transition from face mask to breathing through the endotracheal tube can be dangerous if insertion of the endotracheal tube takes too long, because the mask and oral airway must be removed and the flow of air/oxygen is interrupted while the endotracheal tube is inserted through the patient&#39;s mouth.  
      The typical conventional approach to making this transition involves discontinuing resuscitation and completely removing the mask and oral airway to expose the mouth. The physician inserts a rigid laryngoscope blade into the patient&#39;s mouth and then attempts to insert the endotracheal tube through the patient&#39;s mouth and upper airway and into the trachea in the conventional manner. Cardiac chest compressions are also discontinued during endotracheal tube insertion. The rigid laryngoscope blade is inserted into the mouth and advanced through the upper airway with an appropriate amount of force to distort the naturally curved airway so that the glottis is in straight alignment for direct visualization by the operator. Cardiac chest compressions are interrupted during this time because energy transmission from the vigorous cardiac chest compressions can cause an uncontrolled bouncing movement of the head and neck. Any movement of the head and neck impairs controlled manipulation of the laryngoscope for visualization and tube placement. Uncontrolled movement of the laryngoscope blade during forceful manipulation of the upper airway tissues can result in severe or life-threatening injury. Endotracheal intubation with the rigid laryngoscope blade may require a significant amount of time, even if the patient is motionless. The procedure is more difficult if the patient is less than completely cooperative and relaxed, or if the patient&#39;s airway has suffered trauma, or the tongue has fallen back to close the airway. The patient may not be breathing during this time, or may not be breathing sufficiently to maintain adequate blood oxygen levels, particularly if cardiac arrest is present. If the transition process takes more than a few seconds, the physician must temporarily abandon the effort and return to resuscitation by reinserting the oral airway and replacing the face mask, and then resuming cardiac chest compressions. The transition process may have to be repeated several times before the endotracheal tube is successful installed. In addition, the speed with which the transition process must be completed increases the chances of a mistake being made or unnecessary injury to the patient during the intubation procedure. Irreversible damage to vital organs such as the brain and heart can occur after 30 seconds of interruption of artificial ventilation, and in an even shorter time in the absence of cardiac chest compressions.  
      Endotracheal tubes are also used in semi-emergency situations to ventilate patients with respiratory failure who may be conscious or semi-conscious. The conventional approach requires the patient to lie still while the physician inserts a rigid laryngoscope blade into the patient&#39;s mouth and trachea. Delivery of ventilation and/or oxygen is also interrupted during this period. The endotracheal tube is then inserted into place while the laryngoscope blade keeps the patient&#39;s airway open. Successful intubation depends on the patient being cooperative and completely relaxed, which unfortunately is often not the case. Even with a cooperative patient, intubation is very uncomfortable and can cause the patient to panic due to the difficulty in breathing during the procedure. This procedure can also result in a choking or gagging response that can cause the patient to regurgitate and aspirate contents from the stomach. One conventional response to these shortcomings has been to sedate the patient during intubation. Tranquilizers make the patient more cooperative and less likely to choke during intubation, but also tend to suppress the patient&#39;s breathing and blood pressure. These side effects may be unacceptable when dealing with a patient who already suffers from shallow or irregular breathing or depressed blood pressure. A need exists for improved devices and methods to guide insertion of an endotracheal tube and ensure that the patient&#39;s airway is open, and that also allows the patient to continue to receive air/oxygen and cardiac chest compressions during the insertion process.  
      3. Prior Art.  
      A wide variety of devices that combine face masks with tubes for ventilation (e.g., endotracheal tubes) have been used in the past, including the following:  
                                                       Inventor   Patent No.   Issue Date                          Teves   5,348,000   Sep. 20, 1994           Don Michael   5,339,808   Aug. 23, 1994           Jeshuran   5,197,463   Mar. 20, 1993           Northway-Meyer   4,848,331   Jul. 18, 1989           Kondur   4,580,556   Apr. 8, 1986           Donmichael   4,497,318   Feb. 5, 1985           Dryden   4,256,099   Mar. 17, 1981           Buttaravoli   3,809,079   May 7, 1974           Michael et al.   3,683,908   Aug. 15, 1972                      
 
      Teves discloses a system for dispensing oxygen or anesthesia via an interchangeable face mask and nasal catheter.  
      Don Michael discloses a endotracheal-esophageal intubation device that includes a face mask (see,  FIG. 2  of the Don Michael patent).  
      Jeshuran shows an anesthesia mask that is initially placed over the patient&#39;s mouth and nose as shown in  FIG. 7  of the Jeshuran patent. A fiber optic is inserted through an endotracheal tube, and then through an opening in a two-piece core as shown in  FIG. 9  of the Jeshuran patent. The fiber optic is advanced into the trachea. The head is then unscrewed and the core segments are disassembled to allow the endotracheal tube to be inserted through the mask, as shown in  FIG. 2  of the Jeshuran patent. The fiber optic serves as a guide for insertion of the endotracheal tube. The fiber optic is then withdrawn and the endotracheal tube cuff is inflated, as shown in  FIG. 8  of the Jeshuran patent. However, Jeshuran does not show a curved guide to direct insertion of the fiber optic probe. The physician is faced with the problem of navigating the fiber optic probe past the patient&#39;s tongue and along the airway.  
      Northway-Meyer discloses a device for pulmonary ventilation concurrent with fiber optic examination of the respiratory tract and tracheal intubation. In particular, Northway-Meyer discloses a face mask with a plurality of ports for ventilation and intubation of the patient, and curved guide for advancing an endotracheal tube.  
      Kondur discloses another example of an adapter that allows insertion of an endotracheal tube through the face mask and nose of the patient. Here again, no curved guide is provided.  
      Donmichael discloses an esophageal obturator for blocking aspiration of stomach fluids while the face mask is being used for ventilating the lungs.  
      Dryden discloses a two-tube resuscitation system. One tube is used to supply air to the trachea, while the other tube is used for aspiration or administering medication.  
      Buttaravoli discloses a resuscitator having a face mask with a curved tube for supplying air to the patient&#39;s airway.  
      Michael et al. disclose an apparatus for sealing a patient&#39;s esophagus and providing artificial respiration. The apparatus includes a mouth shield and a curved main tube.  
      In addition, the prior art includes several references involving intubating pharyngeal airways that have a curved central tubular member, including the following:  
                                                       Inventor   Patent No.   Issue Date                          Parker   5,339,805   Aug. 23, 1994           Augustine   5,203,320   Apr. 20, 1993           Berman   4,069,820   Jan. 24, 1978           Berman   4,068,658   Jan. 17, 1978           Berman   4,067,331   Jan. 10, 1978           Berman   4,054,135   Oct. 18, 1977                      
 
      Parker discloses a curved guide for intubation of a patient&#39;s trachea or suctioning of the hypopharynx or esophagus.  
      Augustine discloses a-tracheal intubation guide with a curved forward end.  
      The Berman patents show an intubating pharyngeal airway having a side access for passage of a tube. The side opening can be expanded or closed by means of either a hinge on the opposite side wall of the tube or by a cap  
      Finally, the prior art in the field of laryngeal masks includes the following:  
                                                       Inventor   Patent No.   Issue Date                          Holever   4,240,417   Dec. 23, 1980           Bodai   4,351,328   Sep. 28, 1982           Grimes   4,416,273   Nov. 22, 1983           Brain   4,509,514   Apr. 9, 1985           Brain   4,995,388   Feb. 26, 1991           Brain   5,241,956   Sep. 7, 1993           Brain   5,249,571   Oct. 5, 1993           Brain   5,282,464   Feb. 1, 1994           Brain   5,297,547   Mar. 29, 1994           Brain   5,303,697   Apr. 19, 1994           Brain   5,305,743   Apr. 26, 1994           Brain   5,391,248   Feb. 21, 1995           Brain   5,355,879   Oct. 18, 1994           Brain   5,584,290   Dec. 17, 1996           Brain   5,632,271   May 27, 1997           Owens et al.   5,642,726   Jul. 1, 1997           Brain   5,682,880   Nov. 4, 1977           Brain   5,711,293   Jan. 27, 1998           Pagan   5,771,889   Jun. 30, 1998           Neame et al.   5,871,012   Feb. 16, 1999           Brain   5,878,745   Mar. 9, 1999           Neame et al.   5,881,726   Mar. 16, 1999           Burden   5,890,488   Apr. 6, 1999           Brain   5,896,858   Apr. 27, 1999           Cook   5,937,860   Aug. 17, 1999           Neame et al.   5,979,445   Nov. 9, 1999           Pagan   5,983,897   Nov. 16, 1999           Pagan   6,003,514   Dec. 21, 1999           Pagan   6,012,452   Jan. 11, 2000           Greenfield   6,050,264   Apr. 18, 2000           Brain   6,055,984   May 2, 2000           Brain   6,079,409   Jun. 27, 2000           Pagan   6,116,243   Sep. 12, 2000                      
 
      Holever discloses an adaptor to connect a ventilator to an endotracheal tube, while also permitting insertion of a suction tube.  
      Bodai discloses a system for simultaneous ventilation and endotracheal suctioning of a patient.  
      Grimes discloses a connector valve assembly for endotracheal tubes.  
      The Brain &#39;514 patent discloses a laryngeal mask with a generally elliptical shape and a guide tube.  
      Brain &#39;388 patent discloses a laryngeal mask with a soft flexible collar surrounding the lumen of the mask, and also having a drainage tube.  
      The Brain &#39;956 patent discloses a laryngeal mask airway with concentric drainage for esophageal discharge.  
      The Brain &#39;571 patent discloses a laryngeal clamp airway.  
      The Brain &#39;464 patent discloses a combined laryngeal mask and reflectance oximeter.  
      The Brain &#39;547 patent discloses a laryngeal mask with an inflatable cuff and a V-shaped posterior side.  
      The Brain &#39;697 patent discloses a laryngeal mask with a rigid handle at the proximal end of the guide tube.  
      The Brain &#39;743 and &#39;248 patents disclose a molding process for producing laryngeal masks.  
      The Brain &#39;879 patent discloses a laryngeal mask with inflatable ring and inflatable back cushion.  
      The Brain &#39;290 patent discloses a laryngeal mask with electrodes.  
      The Brain &#39;271 patent discloses a laryngeal mask with a gastric drainage feature.  
      The Brain &#39;880 patent discloses a laryngeal mask with a removable stiffener that can be attached to the guide.  
      The Brain &#39;293 patent discloses a forming tool for deflating a laryngeal mask, such as that shown in the Brain &#39;547 patent, prior to insertion.  
      The Pagan &#39;889 patent discloses a mask assembly having an inflatable ring and a diaphragm attached to a backing plate.  
      The &#39;012 patent to Neame et al. discloses a laryngeal mask with an inflatable bag.  
      The Brain &#39;745 patent discloses a gastro-laryngeal mask with an inflatable cuff and a back cushion to engage the back wall of the pharynx.  
      The &#39;726 patent to Neame et al. discloses a laryngeal mask with a cuff formed by interlocking ribs.  
      Burden discloses a coupling device for placing a stethoscope and an endotracheal tube in gaseous communication.  
      The Brain &#39;858 patent discloses a laryngeal mask with a hinged bar to elevate the epiglottis.  
      Cook discloses a laryngeal mask with an inflatable toroidal peripheral portion having a recessed front notch.  
      The &#39;445 patent to Neame et al. discloses a method for manufacture of a laryngeal mask in which the edges of the cuff are heat-sealed.  
      The Pagan &#39;897 patent discloses a laryngeal mask with cuffs attached on both sides of a plate. The plate also forms a leading tip.  
      The Pagan &#39;452 patent discloses a laryngeal mask with an air line extending to a foam cuff. The cuff can be compressed for insertion by applying suction to the air line.  
      Greenfield discloses a laryngeal mask requiring an obdurator inserted into the tube.  
      The Brain &#39;984 patent discloses an endotracheal tube having tapered, closed nose with a triangular cross-section and lateral openings.  
      The Brain &#39;409 patent discloses a laryngeal mask having a specific geometry for the guide tube and mask.  
      The Pagan &#39;243 patent discloses a laryngeal mask with a plate separating two separate semi-annular cuffs bonded to opposite sides of the plate.  
      4. Solution to the Problem.  
      None of the prior art references discussed above teach or suggest a system that enables the patient to continue to be resuscitated with continued artificial ventilation and cardiac chest compressions while being intubated. In particular, the present system allows the endotracheal tube to be inserted and connected to a ventilator without interrupting the flow of air/oxygen to the patient&#39;s lungs and without interrupting cardiac chest compressions.  
     SUMMARY OF THE INVENTION  
      This invention provides a method and apparatus for guiding insertion of an endotracheal tube into a patient&#39;s trachea during resuscitation. A guide having a mask and a ventilation port is inserted into the patient&#39;s mouth and hypopharynx. The patient is initially resuscitated by supplying a flow of air/oxygen through the ventilation port. A series of cardiac chest compressions are also applied to the patient. An endotracheal tube is inserted over the distal end of a fiber optic probe. Resuscitation continues without interruption of cardiac chest compressions or ventilation while the fiber optic probe and endotracheal tube are advanced along the guide into the patient&#39;s airway. The direction of the distal tip of the fiber optic probe can be controlled by the physician and allows the physician to carefully guide the fiber optic probe and endotracheal tube to a position past the larynx while resuscitation continues. The fiber optic probe is then removed from within the endotracheal tube while leaving the endotracheal tube in place within the trachea. The cuff on the endotracheal tube is inflated and a ventilator is connected to the proximal end of the endotracheal tube to ventilate the patient. Alternatively, the patient can be manually ventilated by connecting a resuscitation bag to the proximal end of the endotracheal tube.  
      A primary object of the present invention is to provide a method and apparatus for guiding insertion of an endotracheal tube that does not require interruption of either cardiac chest compressions or artificial ventilation in the resuscitation process.  
      Another object of the present invention is to provide a method and apparatus for improving insertion of an endotracheal tube by helping to keep the patient&#39;s airway open, and also allowing the physician to guide the insertion process via the fiber optic probe.  
      Another object of the present invention is to provide a method and apparatus for instilling local anesthetic into the patient&#39;s airway and suctioning excess secretions prior to insertion of the endotracheal tube.  
      Another object of the present invention is to provide a method and apparatus for guiding insertion of an endotracheal tube that lessens the risk of injury, particularly during cardiac chest compressions, and reduces patient discomfort.  
      Yet another object of the present invention is to provide a device that enables the physician to instill anesthetic and/or suction secretions from the patient&#39;s mouth and airway as the device is inserted.  
      These and other advantages, features, and objects of the present invention will be more readily understood in view of the following detailed description and the drawings.  
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
      The present invention can be more readily understood in conjunction with the accompanying drawings, in which:  
       FIG. 1  is a front perspective view of the face mask assembly.  
       FIG. 2  is a rear perspective view of the mask assembly corresponding to  FIG. 1 .  
       FIG. 3  is a cross-sectional view of the mask assembly corresponding to  FIG. 1 .  
       FIG. 4  is a front view of the face mask port  23  showing the stretchable opening  24  closed.  
       FIG. 5  is a cross-sectional view of the mouth and airway of a patient after the mask  20  has been initially placed over the patient&#39;s mouth and nose with the curved guide  25  extending into the mouth, over the tongue  14 , and into the hypopharynx  15  while cardiac chest compressions are administered.  
       FIG. 6  is a cross-sectional view of the mouth and airway of the patient corresponding to  FIG. 5  after the fiber optic probe  30  and endotracheal tube  40  have been inserted through the face mask port  23  and advanced along the curved guide  25  to a position below the larynx  18 .  
       FIG. 7  is a front view of the mask port  23  corresponding to  FIG. 6  showing the fiber optic probe  30  and endotracheal tube  40  in cross-section.  
       FIG. 8  is a cross-sectional view of the mouth and airway of the patient corresponding to  FIG. 5  after the fiber optic probe  30  has been removed from within the endotracheal tube  40 .  
       FIG. 9  is a cross-sectional view of the mouth and airway of the patient corresponding to  FIG. 5  showing the face mask  20  being removed while the endotracheal tube  40  remains in place.  
       FIG. 10  is a cross-sectional view of the mouth and airway of the patient corresponding to  FIG. 5  after the mask  20  has been removed, the endotracheal tube cuff  44  has been inflated, and a ventilator  50  has been connected to the endotracheal tube  40 .  
       FIG. 11  is a cross-sectional view of the face mask  20  and guide  25  in an alternative embodiment in which the curved guide  25  is configured as a oral airway that engages the posterior surface of the mask  20  surrounding the face mask port  23 .  
       FIG. 12  is a rear detail view of locking mechanism  21  used to engage the curved guide  25  to the posterior surface of the mask  20 .  
       FIG. 13  is a front perspective view of an alternative embodiment of the face mask assembly.  
       FIG. 14  is a cross-sectional view of the mask assembly corresponding to  FIG. 13 .  
       FIG. 15  is a side elevational view corresponding to  FIGS. 13 and 14  showing the mask assembly  20  placed over the patient&#39;s mouth and nose.  
       FIG. 16  is a front perspective view of a removable resuscitation attachment  70  that can be connected to the ventilation port  62  of the face mask assembly.  
       FIG. 17  is a side view of the resuscitation attachment  70  and flexible tubing  80 .  
       FIG. 18  is a detail side view of an alternative embodiment of the resuscitation attachment  70  in which the location of the oxygen port  76  has been placed below the filter and one-way valve.  
       FIG. 19  is an exploded perspective view of the guide cap assembly.  
       FIG. 20  is a cross-sectional view of the guide cap assembly corresponding to  FIG. 19 .  
       FIG. 21  is a cross-sectional view of the mouth and airway of a patient after the mask  20  has been initially placed over the patient&#39;s mouth and nose, and the curved guide  25  is being advanced along the patient&#39;s airway while administering a local anesthetic from the syringe  55 .  
       FIG. 22  is a perspective view of the stabilizer  120  that can attached to the fiber optic probe of an endoscope.  
       FIG. 23  is a perspective view of the endotracheal tube cap  125  that can be used in conjunction with a stabilizer  120 .  
       FIG. 24  is a cross-sectional view of the mouth and airway of a patient after the face mask  20  has been initially placed over the patient&#39;s mouth and nose, and the stabilizer  120  and endotracheal tube cap  125  have been used to advance the endotracheal tube  40  to a position below the larynx  18 .  
       FIG. 25  is a front perspective view of a guide  25  with a laryngeal mask  130  and a rotatable collar  60  for delivery of air/oxygen through the guide  25 .  
       FIG. 26  is rear perspective view of the guide  25  and laryngeal mask  130  corresponding to  FIG. 25 .  
       FIG. 27  is a cross-sectional view of the guide  25  and laryngeal mask  130  corresponding to  FIG. 25  with the laryngeal mask  130  inflated.  
       FIG. 28  is a detail cross-sectional view of the distal portion of the guide  25  and laryngeal mask  130 .  
       FIG. 29  is a front perspective view of another embodiment of the guide  25  and laryngeal mask  130  in which the ventilation port  62  is fixed relative to the guide  25 .  
       FIG. 30  is a rear perspective view of the guide  25  and laryngeal mask  130  corresponding to  FIG. 29 .  
       FIG. 31  is a front perspective view of another embodiment of the guide  25  and laryngeal mask  130  without a ventilation port.  
       FIG. 32  is a top perspective view of a patient&#39;s airway showing the inlet to the larynx, esophagus, and epiglottis.  
       FIG. 33  is a cross-sectional view of a patient&#39;s airway after the guide  25  and laryngeal mask  130  have been initially inserted.  
       FIG. 34  is a cross-sectional view of the guide  25  and laryngeal mask  130  and the patient&#39;s airway corresponding to  FIG. 33  after the mask  130  has been inflated.  
       FIG. 35  is a cross-sectional view of the patient&#39;s airway, guide  25 , and laryngeal mask  130  corresponding to  FIGS. 33-34  showing a syringe  55  connected to the guide cap  91  to squirt anesthetic through the guide  25  and into the patient&#39;s airway to lessen discomfort.  
       FIG. 36  is a cross-sectional view of the guide  25 , laryngeal mask  130 , and the patient&#39;s airway corresponding to  FIGS. 33-35  after an endotracheal tube  40  has been inserted.  
       FIG. 37  is a cross-sectional view of the guide  25 , laryngeal mask  130 , and the patient&#39;s airway corresponding to  FIGS. 33-36  after the endoscope probe  30  has been withdrawn from within the endotracheal tube  40 .  
       FIG. 38  is a cross-sectional view of the guide  25 , laryngeal mask  130 , and the patient&#39;s airway corresponding to  FIGS. 33-37  after the mask  130  has been deflated and the guide  25  has been removed, leaving the endotracheal tube  40  in place in the patient&#39;s airway.  
       FIG. 39  is a cross-sectional view of the patient&#39;s airway corresponding to  FIGS. 33-38  after the cuff  44  of the endotracheal tube  40  has been inflated and the patient has been connected to a ventilator  50 .  
       FIG. 40  is a cross-sectional view of the patient&#39;s airway corresponding to  FIG. 33-39  in an alternative methodology in which the guide  25  is withdrawn over the endoscope probe  30  while leaving the endotracheal tube  40  in place in the patient&#39;s airway.  
    
    
     DETAILED DESCRIPTION OF THE INVENTION  
      Face Mask Embodiment.  FIGS. 1 through 24  show a first embodiment of the present invention using a face mask. Front and rear perspective views of this embodiment are illustrated in  FIGS. 1 and 2 . A corresponding cross-sectional view is shown in  FIG. 3 . The face mask  20  is adapted to fit over the patient&#39;s mouth and nose for resuscitation of the patient  10  as shown in  FIG. 5 . The mask  20  has a low profile and is made of an elastic material, such as rubber or flexible plastic, to allow the mask to conform to the contours of the patient&#39;s face and create a more air-tight seal around the mouth and nose.  
      The face mask  20  includes a resealable port  23 . In the preferred embodiment, the face mask port  23  consists of a flexible, elastic membrane having a stretchable opening  24  with dimensions large enough to allow a curved guide  25  to pass through the face mask port  23 . For example, this elastic membrane can be made of rubber with slot or hole forming an opening  24 , as shown in  FIG. 4 .  
      As depicted in  FIG. 5 , the curved guide  25  can be readily inserted through the face mask port  23  while maintaining a substantially air-tight seal around the guide  25  to prevent gas from escaping from within the face mask  20 . The guide  25  is generally tubular and includes a resealable port  27  at its proximal end. For example, the guide port  27  can be made of a flexible, elastic membrane having a stretchable slot or opening  28  with dimensions large enough to allow an endotracheal tube to pass through the guide port  27 . The guide  25  extends posteriorly through the face mask  20  and has a curved distal portion that is inserted into the patient&#39;s mouth and hypopharynx  15  as the face mask  20  is placed over the patient&#39;s mouth. The distal portion of the curved guide  25  is generally J-shaped to follow the profile of a typical patient&#39;s airway through the mouth, over the tongue  14 , and into the hypopharynx  15  just above the opening to the trachea  16 . The guide  25  is shaped to be easily inserted along the normal anatomic curvature without forceful distortion of the upper airway, and to prevent the patient&#39;s tongue  14  and collapsible pharynx from obstructing access to the trachea  16 , while also defining a channel for later insertion of an endotracheal tube. The guide  25  is typically made of plastic with sufficient strength and rigidity to keep the patient&#39;s teeth apart and prevent the patient from biting down on the endotracheal tube. The face mask port  23  allows the guide  25  to slide relative to the face mask  20 , and also allows a limited range of rotation of the guide  25 . This flexibility allows the guide  25  to accommodate a wide range of patient sizes and conditions.  
      In the preferred embodiment, the guide  25  is equipped with small tube  29  bonded to the exterior of the guide  25  that extends along the length of the guide  25  to its distal end. This tube  29  can be used to suction secretions from the patient&#39;s mouth and airway as the guide  25  is advanced. Alternatively a syringe  55  containing a local anesthetic (e.g., lidocaine or xylocaine) can be connected to the proximal end of the tube  29  to squirt anesthetic as the guide  25  is insert through the patient&#39;s mouth and into the hypopharynx  15 , as illustrated in  FIG. 5 . If squirted with sufficient force, the anesthetic can be carried as far as the larynx  18  to deaden any discomfort associated with insertion of the endotracheal tube  40 . Alternatively, the physician can squirt anesthetic directly down the main passageway of the guide  25 . The main passageway can also be used for suctioning secretions from the patient&#39;s mouth and airway.  
      The patient is initially resuscitated by supplying a flow of air/oxygen through the mask. For example, the flow of air can be supplied by a resuscitation bag  22  attached to the mask  20  that is manually squeezed periodically to simulate natural breathing. However, other conventional air/oxygen supplies for resuscitation could be substituted at the connector for the face mask  20 . In the preferred embodiment, the flow of oxygen/air from the resuscitation bag  22  is directed around the exterior of the curved guide  25 . This tends to inflate the patient&#39;s mouth and airway, which distends the collapsible tissues, and thereby makes visualization and insertion of the endotracheal tube  40  easier.  
      A series of cardiac chest compressions can be applied to the patient&#39;s chest, as shown in  FIG. 5 , throughout this process to stimulate blood circulation. This is similar to conventional cardiopulmonary resuscitation (CPR). Studies have shown that continuing cardiac chest compressions can be critical. Even a relatively brief interruption of cardiac chest compressions can increase the risk of a negative outcome or neurological damage to the patient. Therefore, it is important to be able to continue cardiac chest compressions, as well as artificial ventilation, during the intubation process. Unlike the metal laryngoscope blades commonly found in the prior art, the guide  25  in the present invention does not create a risk of injury to the patient&#39;s airway if cardiac chest compressions continue during intubation.  
      After the patient&#39;s condition has been stabilized to some degree during initial resuscitation, an endotracheal tube  40  is inserted over a fiber optic probe  30 . The fiber optic probe  30  and endotracheal tube  40  are then inserted through the guide port  27  and along the guide  25  to a position within the trachea  16  past the larynx  18  while resuscitation continues, as illustrated in  FIG. 6 . The opening  28  in the flexible membrane stretches to allow the endotracheal tube  40  and fiber optic probe  30  to pass through the guide port  27 , but maintains a sufficiently tight fit around the endotracheal tube  40  to prevent the escape of gas from within the mask  20 , as shown in the front view of the face mask provided in  FIG. 7 .  
      The fiber optic probe  30  allows the physician to view within the patient&#39;s mouth and trachea  16  during insertion. Unlike the rigid laryngoscope blade, the fiber optic probe is flexible and can easily navigate curvatures. The physician can also remotely manipulate the direction of the probe tip  32  to control the direction of the fiber optic probe  30 . The ability to easily steer the fiber optic probe, and the advanced optics and light source allow for adequate visualization, even during motion form cardiac chest compressions. The flexible tip of the fiber optic scope is designed to be atraumatic. These features minimize patient discomfort and risk of injury to the patient. The small size of the fiber optic probe  30  also allows the physician to thread the fiber optic probe  30  through relatively constricted areas within the airway, such, as the larynx  18 . Most importantly, the fiber optic probe  30  and endotracheal tube  40  do not interfere with ongoing resuscitation of the patient and continued cardiac chest compressions.  
      The distal end  46  of the endotracheal tube  40  can beveled as illustrated most clearly in  FIG. 6 . Experience has shown that injury to the larynx  18  can be reduced by spinning the endotracheal tube  40  as it is advanced. The beveled end tends to keep the endotracheal tube  40  centered as it is passes through the vocal cords. Injury to the lining of the mouth and trachea can be reduced by using an endotracheal tube  40  made of a material having a low coefficient of friction, such as silicone. Bivona Medical Technologies of Gary, Indiana, markets a line of endotracheal tubes made of silicone with a helical reinforcing wire.  
      After the endotracheal tube  40  has been inserted, the fiber optic probe  30  is removed from within the endotracheal tube  40  through the proximal end of the endotracheal tube  40 , as depicted in  FIG. 8 . The face mask  20  and guide  25  can then be removed while leaving the endotracheal tube  40  in place within the trachea  16 , as shown in  FIG. 9 . The opening  28  in the flexible port  27  allows the face mask  20  and guide  25  to be withdrawn over the connector  42  at the proximal end of the endotracheal tube  40  with minimal effort and dislocation of the endotracheal tube  40 . The position of the endotracheal tube  40  can be stabilized while the mask  20  is removed by manually gripping the proximal end of the endotracheal tube  40  and gradually urging it through the guide port  27  as the mask  20  is lifted from the patient&#39;s face. The physician can then reach under the face mask  20  to grip the endotracheal tube  40  after the mask  20  has been lifted sufficiently to allow access.  
      Alternatively, the face mask  20  can be removed while leaving the guide  25  in place to serve as an oral airway and to protect the endotracheal tube  40  from being bitten by the patient&#39;s teeth. After the face mask  20  has been removed, the endotracheal tube is taped to the patient&#39;s face, or held in place by some other suitable means for attachment.  
      The cuff  44  at the distal end  46  of the endotracheal tube  40  is then inflated through the port valve  45  to block the trachea  16 . An external ventilator  50  can be attached to the connector  42  at the proximal end of the endotracheal tube  40 , as shown in  FIG. 10 . The patient can then be mechanically ventilated in the conventional manner via the endotracheal tube  40 . Alternatively, the patient can be manually ventilated by attaching a resuscitation bag to the connector  42  at the proximal end of the endotracheal tube.  
      It should be understood that the guide  25  and mask  20  can have any number of possible embodiments. The embodiment shown in the  FIGS. 1-9  uses a guide  25  that extends through an elastic port  23  in the face mask  20 . This allows a limited range of motion between the guide  25  and mask  20  to make insertion of the guide easier, but requires two elastic ports  23  and  28 . Alternatively, the guide  25  and mask  20  could be fabricated as two separate pieces that engage one another, as illustrated in  FIG. 11 . This eliminates the need for the guide port  27 . In this embodiment, the guide  25  is separately inserted into the mouth, similar to a conventional oral airway. The mask  20  is then placed over the patient&#39;s mouth and nose so that the proximal end of the guide  25  engages a corresponding opening in the posterior face of the mask  20  to provide a relatively continuous passageway for insertion of the fiber optic probe  30  and endotracheal tube  40  through the face mask port  23  and along the guide  25 .  FIG. 12  provides a rear detail view of the locking mechanism  21  used to engage the guide  25  to the posterior face of the mask  20 . The guide  25  can be readily disengaged by rotating it slightly relative to the face mask  20 . After the endotracheal tube  40  has been inserted, the mask  20  is removed while leaving the guide  25  in place within the patient&#39;s mouth. The guide  25  remains around the endotracheal tube  40  and protects it from being bitten or crimped by the patient&#39;s teeth.  
      The guide  25  can consist of a J-shaped tubular member as shown in the drawings. The J-shaped tubular member is preferred as there are no edges to injure the airway. Alternatively, the distal portion of the guide  25  can have a U-shaped cross-section. The guide  25  can be molded from a suitable plastic material having a relatively low coefficient of friction to minimize irritation to the lining of mouth and trachea and to minimize resistance to insertion of the endotracheal tube  40  along the guide. Friction can be further reduced by applying a slippery coating to both the exterior and interior surfaces of the guide  25 . A slippery coating can also be applied to the endotracheal tube to minimize friction between the endotracheal tube and the guide.  
      All of the components necessary to practice the present invention can be readily packaged as a kit for use in emergency rooms and intensive care units. The kit is sufficiently compact and inexpensive that it can be stocked on resuscitation carts widely used in hospitals, and carried in ambulances for use by emergency medical technicians in the field. The fiber optic probe can be operated using a battery-powered light source. The oxygen supply for the hospital or ambulance can be connected to the face mask  20  for resuscitation or to provide a flow of gas to the ventilator  50 . The tube  29  extending along the guide  25  can also be connected to the suction system provided by the hospital or ambulance, if necessary.  
       FIG. 13  is a front perspective view of an alternative embodiment of the face mask assembly with a rotating ventilation port.  FIG. 14  shows a cross-sectional view of the mask assembly corresponding to  FIG. 13 .  FIG. 15  is a side elevational view showing the mask assembly  20  placed over the patient&#39;s mouth and nose.  
      In contrast, the embodiment of the present invention illustrated in  FIGS. 1-12  has a fixed ventilation port for connecting a resuscitation bag  22  or other source of air/oxygen to the face mask  20 . This limitation may present a significant problem in emergency situations in which only limited access to the patient is available, or in which the patient cannot be readily moved. Similar problems can also occur in a hospital setting, due to the patient&#39;s position in bed, or surrounding medical equipment that can limit access to the patient from one side or the other.  
      Returning to  FIGS. 13-15 , the mask assembly includes a rotatable annular ventilation collar  60  with a ventilation port  62  that can be connected to a conventional respiration bag  22  or other air/oxygen source to ventilate the patient. The ventilation collar  60  allows the ventilation port  62  to be freely rotated to any desired orientation about the face mask port  23 . Flexibility in the approach to the patient for artificial ventilation and intubation increases access of the individual performing simultaneous cardiac compressions.  
      Air from the resuscitation bag  22  flows through the ventilation port  62  and into the annular ventilation collar  60 . It then flows through a plurality of small ventilation holes  66  in the mask  20  beneath the annular ventilation collar  60  into the patient&#39;s mouth and nose. The resuscitation bag  22  is typically used to initially resuscitate the patient, and to provide short-term ventilation until the endotracheal tube is in place and connected to a ventilator. After the patient has been intubated and connected to the ventilator, the resuscitation bag  22  can be removed. If needed, the resuscitation bag  22  can reconnected to the ventilation port  62  to supplement the flow provided by the ventilator.  
      In particular, the mask  20  includes a raised cylindrical flange  63  that engages a corresponding flange  64  extending around the base of the annular ventilation collar  60  to provide a rotatable, but generally air-tight seal between the mask  20  and the ventilation collar  60 . A tubular member  67  extends upward from the surface of the mask  20  beneath the ventilation collar  60 , and passes through the central opening in the annular ventilation collar  60 . An O-ring  65  provides a rotatable, air-tight seal between the outer surface of the tubular member  67  and the ventilation collar  60 , and also serves to retain the ventilation collar in place on the mask assembly  20 .  
      A resealable face mask port  23  is provided at the upper opening of the tubular member  67 , so that a curved guide  25  can be removably inserted through the face mask port  23  and into the patient&#39;s mouth and hypopharynx  15 , as illustrated in  FIG. 5 . When the face mask port  23  is not in use (e.g., during initial resuscitation of a patient using the resuscitation bag  22 ), the face mask port  23  should remain sealed to prevent gas from escaping from the face mask  20 . For example, the face mask port  23  can be a flexible membrane that has a stretchable opening to receive the guide  25 . When the guide  25  is not inserted through the face mask port  23 , the flexible membrane retracts to substantially seal the opening and prevent gas from escaping from the face mask port  23 , as previously discussed. Alternatively, the face mask port  23  can be equipped with a removable cap to seal the port with it is not in use.  
       FIG. 16  is a perspective view of a removable resuscitation attachment  70  that can used in place of the resuscitation bag  22  for mouth-to-mask resuscitation by the rescue person. In a hospital setting, the first person responding to a patient in need of resuscitation typically activates an alarm to summon a resuscitation team, and then immediately begins mouth-to-mouth resuscitation of the patient until the resuscitation team arrives. To help minimize the risk of contamination, many hospitals equip each hospital bed with a face mask having a ventilation port for mouth-to-mask resuscitation. This type of face mask is also commonly provided for use by police and firemen with little medical training. When the resuscitation team arrives, this face mask is generally replaced with a system consisting of a second face mask, an oral airway, and a resuscitation bag. Since the patient usually requires intubation, this second face mask must be removed while an endotracheal tube is inserted into the patient&#39;s airway and the patient is connected to a ventilator. Each of these transitions entails an interruption in on-going cardiac chest compressions and artificial ventilation during resuscitation efforts, which can be detrimental to the patient. According to the American Heart Association, a period in excess of 30 seconds without breathing or circulation can cause irreversible brain and heart damage. Similarly, damage can occur if cardiac chest compressions are interrupted for much shorter periods.  
      In addition, the most common types of face masks used for initial resuscitation at the patient&#39;s bed do not include a guide or oral airway to keep the patient&#39;s airway open. As a result, initial efforts at manual resuscitation using the first face mask may be partially or completely ineffective, until the resuscitation team arrives and replaces the first face mask with a second face mask and a separate airway device used to keep the patient&#39;s airway open.  
      In contrast to the conventional approach practiced in many hospitals, as described above, the present invention allows the same face mask to be used throughout the entire process without interrupting resuscitation. In addition, the present invention includes a face mask with a curved guide that can be inserted into the patient&#39;s airway to maintain patency during the first effort to resuscitate the patient before the resuscitation team arrives.  
      Returning to  FIG. 16 , the resuscitation attachment  70  has an output port  71  that can be removably connected to the ventilation port  62  of the face mask  20 . The healthcare provider administers mouth-to-mask resuscitation to the patient via the resuscitation attachment  70  and face mask  20 .  
      The resuscitation attachment  70  includes an air filter  74  across the flow path between the input port  72  and output port  71 , to help prevent the exchange of contaminants between the healthcare provider and patient. A one-way valve  75  (e.g., a duckbill valve) directs any backflow of air or contaminated fluids from the face mask  20  to the exhaust port  73 , and thereby serves to further protect the healthcare provider from contaminants.  
      The healthcare provider can breathe directly into the input port  72  of the resuscitation attachment  70 . Alternatively, a length of flexible tubing  80  can be connected to the resuscitation attachment  70  by means of a connector  82  that can be plugged into the input port  72  of the resuscitation attachment  70 , as shown in  FIG. 17 . In the preferred embodiment, the flexible tubing  80  is approximately six inches in length and forms a helical coil for easier storage. The proximal end of the flexible tubing  80  has a mouthpiece  84  with an oval opening.  
      The resuscitation attachment  70  can also be equipped with an oxygen port  76 , as shown in  FIG. 17 , that can be connected by tubing to a external oxygen source to supply supplemental oxygen to the patient through the flow path, in addition to the mouth-to-mask resuscitation provided by the healthcare provider. Each exhalation by the healthcare provider then carries oxygen-enriched air through the face mask  20  and into the patient&#39;s lungs. The oxygen port  76  can be closed with a removable cap  77  when the oxygen port  76  is not in use. The internal passageway within the flexible tubing  80  and resuscitation attachment  70  upstream from the one-way valve  75  serve as a reservoir for accumulation of oxygen between each exhalation by the healthcare provider.  
       FIG. 18  shows an alternative embodiment of the resuscitation attachment  70  with the oxygen port  76  placed below the one-way valve  75  and filter  74 . In this embodiment, the internal passageway within the resuscitation attachment  70  downstream from the one-way valve  75  serves as a reservoir for accumulation of oxygen between each exhalation by the healthcare provider. The one-way valve  75  helps to prevent oxygen from escaping during the remainder of the resuscitation cycle. However, the exhalation port  73  prevents the build-up of excessive pressure that might be injurious to the patient&#39;s lungs.  
       FIGS. 19-21  show a removable cap assembly that can be used to seal the proximal end of the tubular guide  25  in place of the guide port  27  shown for example in  FIGS. 1, 4 , and  7 . As shown in the exploded perspective view of the cap assembly provided in  FIG. 19 , the guide cap  91  has an outside diameter dimensioned to seat into the proximal opening of the guide  25 . A central passageway extends through the guide cap  91 . As shown in the cross-sectional view provided in  FIG. 20 , a luer connector  92  with a one-way valve  93  (e.g., a duck-bill valve) is permanently attached to the guide cap  91  so that air or fluid can only flow down the passageway of the guide cap  91 , but not up. Thus, the one-way valve  93  serves to prevent air/oxygen from escaping from within the face mask  20  during initial resuscitation.  
      As illustrated in the cross-sectional view provided in  FIG. 21 , a syringe  55  containing anesthetic can be secured to the luer connector  92  on the guide cap  91 . As the guide  25  is advanced into the patient&#39;s mouth and hypopharynx, the healthcare provider squirts anesthetic from the syringe  55 , through the one-way valve  93  and guide  25  to lessen discomfort.  
      After the guide  25  has been advanced into position, the guide cap  91  is removed from the guide  25  to allow insertion of the endotracheal tube  40  through the guide  25 , as previously discussed. An annular ring  26  within the proximal end of the guide  25  forms a loose seal around the endotracheal tube  40  to help prevent air/oxygen from escaping as the endotracheal tube  40  is being inserted.  
       FIGS. 22-24  show another embodiment in which a stabilizer  120  is attached to the endoscope probe  30  and then used to advance the endotracheal tube  40  along the guide  25  and into the patient&#39;s trachea. In the preferred embodiment, the stabilizer  120  is a flexible plastic tube having a C-shaped cross-section, as shown in  FIG. 22 , that can be readily clipped over the fiber optic probe  30  at any desired location along its length.  
      The inside diameter of the stabilizer  120  should be selected to provide a snug, frictional fit against the exterior of the fiber optic probe  30  so that the stabilizer  120  will not readily slide after it has been attached to the fiber optic probe  30 . The stabilizer  120  can also be readily removed from the endoscope probe  30  by the healthcare provider for cleaning or to adjust its location on the probe  30 . The stabilizer  120  should have outside dimensions sufficiently large to push the endotracheal tube forward as the fiber optic probe  30  is advanced by the healthcare provider, and sufficiently small to fit through the face mask port.  
      The proximal end of the endotracheal tube  40  can be fitted with a removable cap  125  shown in  FIG. 23 . This cap  125  has outside dimensions selected so that it can be inserted snugly into the proximal opening of the endotracheal tube  40  and yet is sufficiently small to fit through the face mask port, if necessary.  
      A central passageway extends axially through the cap  125  to receive the fiber optic probe  30 . The fiber optic probe  30  passes freely through the cap  125 . However, the cap passageway has an inside diameter smaller than the stabilizer  120 , so that the stabilizer  120  will abut and push against the proximal end of the endotracheal tube  40  as the fiber optic probe  30  is advanced by the healthcare provider.  
      In practice, this embodiment of the present invention typically uses the following sequence of steps. First, the face mask  20  is placed over the patient&#39;s mouth and the patient is initially resuscitated by a flow of air/oxygen delivered through the face mask ventilation port. With the guide cap  91  sealing the proximal end of the guide  25 , the distal portion of the guide  25  is advanced by the healthcare provider into the patient&#39;s mouth and hypopharynx, as previously discussed. If necessary, a syringe  55  can be attached to the guide cap  91  to spray anesthetic down the guide  25  and into the patient&#39;s airway to less discomfort.  
      The stabilizer  120  is attached at a desired position on a fiber optic probe  30  of the endoscope. The fiber optic probe  30  is then inserted into the proximal end of the endotracheal tube  40  until the stabilizer  120  abuts the proximal end of the endotracheal tube  40 . The location of the stabilizer  120  on the fiber optic probe  30  is normally selected so that the distal tip of the fiber optic probe  30  will extend slightly beyond the distal tip  46  of the endotracheal tube  40 .  
      Optionally, a removable endotracheal tube cap  125  is attached to the proximal end of the endotracheal tube  40  prior to insertion of the fiber optic probe  30  so that the stabilizer  120  will push against this cap  125  as the healthcare provider advances the fiber optic probe  30 . In this variation, the fiber optic probe  30  is inserted through both the endotracheal tube cap  125  and the endotracheal tube  40 .  
      The guide cap  91  and syringe  55  are removed from the guide  25 , and the assembly consisting of the endotracheal tube  40 , fiber optic probe  30  and stabilizer  120  is inserted through the proximal end of the guide  25 . The healthcare provider then pushes forward on the fiber optic probe  30  to advance the endotracheal tube  40  and the fiber optic probe  30  along the guide  25  and into the patient&#39;s trachea  16  as shown in  FIG. 24 . If the fiber optic probe  30  is part of a conventional endoscope, the healthcare provider can view through the endoscope probe  30  and manipulate the controls on the endoscope housing  31  to navigate the distal portion of the endotracheal tube  40  through the larynx and into the pharynx. Many conventional endoscopes include a suction channel extending the length of the fiber optic probe to its distal tip. This feature can be used to suction mucus or other secretions from the patient&#39;s airway as the endoscope/endotracheal tube assembly is inserted.  
      After the endotracheal tube  40  has been moved into position with its distal end in the trachea, the face mask  20  is removed over the proximal end of the endotracheal tube  40  while leaving the endotracheal tube  40  and fiber optic probe  30  in place. More specifically, the face mask  20  and guide  25  can either be removed together, or the face mask  20  can be remove first followed by the guide  25 .  
      Before removing the face mask  20  and guide  25 , the healthcare provider may wish to slide the stabilizer  120  a few centimeters toward the distal end of the fiber optic probe  30 . This allows the endoscope to be pulled back relative to the endotracheal tube  40 , so that the distal tip of the endoscope is located within the distal end of the endotracheal tube  40  and offers a view of both the endotracheal tube&#39;s distal tip and the patient&#39;s trachea. This enables the healthcare provider to monitor the position of the endotracheal tube  40  relative to the trachea as the face mask  20  and guide  25  are removed, as described above.  
      The fiber optic probe  30  is then withdrawn from within the endotracheal tube  40  and the endotracheal tube cap  125  is removed if one is present. Finally, the patient can be ventilated via a conventional ventilator connected to the endotracheal tube  40 . Cardiac chest compressions can continue along with artificial ventilation through the entire intubation process.  
      Pharyngeal Mask Embodiment. Turning to  FIGS. 25 and 26 , front and rear perspective views are provided of an alternative embodiment of the present invention using a laryngeal mask  130  in place of a face mask to ensure that the flow of air/oxygen delivered via the ventilation port  62  is delivered into the patient&#39;s lungs. This embodiment includes a tubular guide  25  with a laryngeal mask  130  surrounding its distal end.  FIG. 27  is a corresponding cross-sectional view of the guide  25  with the laryngeal mask  130  inflated.  FIG. 28  is a detail end view of the laryngeal mask  130  and the distal portion of the guide  25 . The size and shape of the guide  25  are selected so that its distal portion can be readily inserted into the patient&#39;s mouth and upper airway with the laryngeal mask  130  substantially sealing the glottis  19 , as shown in  FIGS. 33-37 . The proximal end of the guide  25  remains outside of the patient&#39;s mouth and therefore is accessible to the healthcare provider.  
      As before, the guide  25  is generally J-shaped to follow the profile of a typical patient&#39;s airway through the mouth, over the tongue  14 , and into the laryngopharynx  15  just above the opening to the larynx  18  (see  FIGS. 32 and 33 ). The guide  25  is shaped to prevent the patient&#39;s tongue  14  and collapsible pharynx from obstructing access to the trachea, while also defining a channel for later insertion of an endotracheal tube. The previously discussed safety and visualization benefits during concurrent cardiac chest compressions, as described above, apply to guide  25  of this invention. The guide  25  is typically made of plastic with sufficient strength and rigidity to keep the patient&#39;s teeth apart and prevent the patient from biting down on the endotracheal tube. This flexibility allows the guide  25  to accommodate a wide range of patient sizes and conditions. The inside diameter of the guide  25  should be sufficiently large to allow an endotracheal tube  40  to freely pass through the guide  25 , as shown for example in  FIG. 36 , with extra room to allow air/oxygen to flow through the guide  25  around the endotracheal tube  40 . Preferably, the distal opening of the guide  25  is beveled to substantially match the angle of the glottis  19  after insertion of the guide  25  into the patient&#39;s airway.  
      The laryngeal mask  130  consists a central support member  131  extending outward from the guide  25  to an inflatable member as illustrated in  FIGS. 25-28 . The laryngeal mask  130  is preferably made of a soft, flexible material (e.g., a polymer or rubber) to enable it to be advanced into position without injury to the patient and to create a substantially air-tight seal about the glottis  19 . The degree of inflation of the laryngeal mask  130  can be adjusted through a small inflation tube  134  and air valve  132 . Alternatively, the laryngeal mask  130  can be a cushion made of a soft, spongy material that is not inflatable. The laryngeal mask  130  and its support member  131  are shaped to meet several requirements. The lower portion  135  of the laryngeal mask  130  substantially blocks the esophagus to minimize the risk of regurgitation of stomach contents and the passage of air into the stomach. The upper portion  136  of the laryngeal mask  130  guides the distal end of the guide  25  into alignment with the glottis  19  as the guide is inserted along the patient&#39;s airway.  
      In the embodiment shown in the drawings, the laryngeal mask  130  is generally boot-shaped when inflated. The lower portion  135  of the laryngeal mask  130  forms the toe of the boot, which blocks the esophagus. The lower portion  135  of the laryngeal mask  130  also helps to align the distal opening of the guide  25  with the patient&#39;s glottis  19 . After the mask  130  is inflated, the upper portion  136  of the mask  130  substantially fills the laryngopharynx  15  at the level of the glottis  19 . The upper portion  136  of the laryngeal mask  130  surrounds the glottis  19  so that the distal opening of the guide  25  is sealed in fluid communication with the glottis  19 . Thus, substantially all of the gas inhaled or exhaled by the patient passes through the guide  25 . For example, the laryngeal mask  130  can be formed by injection blow molding, rotational molding, or dip molding.  
      In particular, the upper portion  136  of the mask  130  surrounding the distal opening of the guide  25  is canted at an angle to complement the natural angle of the glottis  19 . The distal end of the guide  25  can also be beveled at this complementary angle. This enables the laryngeal mask  130  to directly engage the glottis  19  along the longitudinal axis of the patient&#39;s airway as the guide  25  is advanced. The shape of the upper portion  136  of the laryngeal mask  130  further helps to guide the distal opening of the guide  25  so that it is axially aligned with the glottis  19  and abuts the glottis  19  in an end-on relationship as the guide is inserted along the patient&#39;s airway. In contrast, conventional laryngeal masks typically approach the glottis  19  from a posterior or inferior position.  
      In the embodiment depicted in  FIGS. 25-28 , the proximal end of the guide  25  can be sealed by a removable guide cap  91  as shown in  FIG. 19, 20 , and  33 - 35 .  FIG. 33  is a cross-sectional view of a patient&#39;s airway after the guide  25  has been initially inserted. As shown in  FIG. 33 , the guide cap  91  has an outside diameter dimensioned to seat into the proximal opening of the guide  25  and thereby prevent the escape of gas through this opening. When inserted, the guide cap  91  abuts and seals against an annular seal ring  26  within the guide  25  as illustrated in  FIG. 33 . The guide cap  91  has a small passageway or port extending vertically through the guide cap  91 . As shown in  FIG. 20 , a luer connector  92  with a one-way valve  93  (e.g., a duck-bill valve) is permanently attached to the guide cap  91  so that air or fluid can only flow down the passageway of the guide cap  91 , but not up. Thus, the one-way valve  93  serves to prevent air/oxygen from escaping through the guide  25  during resuscitation.  
      As illustrated in  FIG. 35 , a syringe  55  containing anesthetic can be secured to the luer connector  92  on the guide cap  91 . As the guide  25  is advanced into the patient&#39;s mouth and hypopharynx, the healthcare provider squirts anesthetic from the syringe  55 , through the one-way valve  93  and guide  25  to lessen discomfort. After the guide  25  has been advanced into position, the guide cap  91  is removed from the guide  25  to allow insertion of an endotracheal tube  40  and fiber optic probe  30  through the guide  25 , as will be discussed below.  
      A flow of air/oxygen is delivery to the patient via the guide  25  through a ventilation port  62  extending at an angle from the side of the guide  25 . A rotatable collar  60  allows the ventilation port  62  to be rotated about the central axis of the guide  25  to any desired orientation. Air/oxygen flows through the ventilation port  62  into the annular space between the collar  60  and the guide  25 , and through a series of ventilation holes  66  into the interior of the guide  25 , as shown in greater detail in  FIG. 27 . For example, the ventilation port  62  can be connected to a conventional ventilator or a resuscitation bag. Alternatively, a mouthpiece can be connected to the ventilation port  62  for initial patient resuscitation by a healthcare provider, as discussed above.  
       FIGS. 29 and 30  are front and rear perspective views of another embodiment of the present device in which air/oxygen is introduced directly into the guide  25  through a fixed ventilation port  62 . This embodiment would be simpler and less expensive to build.  
       FIG. 31  is a front perspective view of yet another embodiment of the guide  25  without a separate ventilation port. The patient can be supplied with air/oxygen through a connector or cap placed in the proximal opening of the guide  25  having a ventilation port (not shown).  
      The following is a description of a typical method of use for the present invention. The curved distal portion of the guide  25  is first inserted into the patient&#39;s mouth and laryngopharynx  15  with the laryngeal mask  130  deflated, as shown in  FIG. 33 . If necessary, the ventilation port  62  can be used as a hand grip during insertion of the guide  25 .  FIG. 32  is a corresponding top perspective view of a patient&#39;s airway, including the larynx  18 , esophagus  13 , and epiglottis  13 . The positions of the guide  25  and laryngeal mask  130  relative to the patient&#39;s anatomy after insertion are shown in dashed lines in  FIG. 32 . The lower portions of the support member  131  and laryngeal mask  130  extend into the esophagus  13 . The upper portions of the support member  131  and the laryngeal mask  130  surround the glottis  19 .  
      A protrusion  133  on the anterior portion of the distal tip of the guide  25  or support member  131  is inserted to the patient&#39;s vallecula  17  (i.e., the notch between the base of the tongue  14  and the epiglottis  13 . The protrusion  133  pushes on the vallecula  17 , which tends to lift the epiglottis  13  from the glottis  19  and helps to ensure patency of the patient&#39;s airway.  
      After the distal portion of the guide  25  and the laryngeal mask  130  are appropriately positioned relative to the glottis  19 , the laryngeal mask  130  is inflated via the inflation tube  134  to establish a seal around the glottis  19 , as depicted in  FIG. 34 . The lower portion  135  of the inflated laryngeal mask  130  substantially blocks the esophagus  13 . The upper portion  136  of the inflated laryngeal mask  130  substantially fills the laryngopharynx  15  adjacent to the glottis  19 , and thereby seals the distal opening of the guide  25  in fluid communication with the glottis. The side portions  137  and  138  (shown in  FIG. 28 ) pinch the sides of the epiglottis  13 , which also tends to lift the epiglottis  13  from the glottis  19 .  
      If necessary, the guide cap  91  can be removed and an endoscope probe can be inserted through the proximal end of the guide  25  to enable the physician to view the insertion process and verify that the laryngeal mask  130  is correctly positioned.  
      Optionally, a syringe  55  containing a local anesthetic (e.g., lidocaine or xylocaine) can be connected to the luer connector on the guide cap  91  at the proximal end of the guide  25  to squirt anesthetic as the guide  25  is inserted through the patient&#39;s mouth and into the laryngopharynx  15 , as shown in  FIG. 35 . If squirted with sufficient force, the anesthetic can be carried as far as the larynx  18  to deaden any discomfort associated with insertion of the guide  25 , laryngeal mask  130 , and endotracheal tube  40 .  
      During and after insertion of the guide  25 , the patient can be resuscitated by supplying air/oxygen through the ventilation port  62 . For example, the flow of air can be supplied by a resuscitation bag attached to the ventilation port  62  that is manually squeezed periodically to simulate natural breathing. Alternatively, a resuscitation attachment (such as shown in  FIGS. 16-18 ) can be removably attached to the ventilation port  62  to enable a healthcare provider to directly resuscitate the patient. As previously discussed, a series of cardiac chest compressions can also be administered to the patient&#39;s chest while artificial ventilation continues and during the intubation and resuscitation processes.  
      After the patient&#39;s condition has been stabilized to some degree during initial resuscitation, an endotracheal tube  40  is inserted over the distal end of an endoscope probe  30 . The guide cap  91  is removed from the proximal end of the guide  25 . Resuscitation, oxygenation, or artificial ventilation continue without interruption while the endoscope probe  30  and endotracheal tube  40  are advanced along the guide  25  and through the laryngeal mask  130  to a position within the trachea past the larynx  18 .  FIG. 36  is a cross-sectional view of the present-device during insertion of the endotracheal tube  40  and endoscope probe  30 .  
      The seal ring  26  within the proximal end of the guide  25  has an inside diameter that is only slightly larger than the outside diameter of the endotracheal tube  40 . This allows the endotracheal tube  40  to pass through the seal ring  25  and along the guide  25 , but maintains a sufficiently tight fit around the endotracheal tube  40  to reduce the escape of gas through the seal. However, air/oxygen flows freely through the space between the endotracheal tube  40  and the surrounding guide  25  to maintain patient respiration.  
      Optionally, a removable cap  125  can be inserted into the proximal end of the endotracheal tube  40  and a stabilizer tube  120  can be attached to the endoscope probe  30 , as shown in  FIG. 36 , to assist in advancing the endotracheal tube  40  along the guide  25 . In the preferred embodiment, the stabilizer  120  is a flexible plastic tube having a C-shaped cross-section, as shown in  FIG. 22 , that can be readily clipped over the fiber optic probe  30  at any desired location along its length. The inside diameter of the stabilizer  120  should be selected to provide a snug, frictional fit against the exterior of the endoscope probe  30  so that the stabilizer  120  will not readily slide after it has been attached to the fiber optic probe  30 . The stabilizer  120  can also be readily removed from the endoscope probe  30  by the healthcare provider for cleaning or to adjust its location on the probe  30 . The stabilizer  120  should have outside dimensions sufficiently large to push the endotracheal tube  40  forward as the fiber optic probe  30  is advanced by the healthcare provider.  
      The proximal end of the endotracheal tube  40  can be fitted with a removable cap  125  shown in  FIG. 23 . This cap  125  has outside dimensions selected so that it can be inserted snugly into the proximal opening of the endotracheal tube  40  and yet is sufficiently small to pass through the guide  25 , if necessary. A central passageway extends axially through the endotracheal tube cap  125  to receive the endoscope  30 . The endoscope probe  30  passes freely through the cap  125 . However, the cap passageway has an inside diameter smaller than the stabilizer  120 , so that the stabilizer  120  will abut and push against the proximal end of the endotracheal tube  40  as the fiber optic probe  30  is advanced by the healthcare provider. This approach enables the endotracheal tube  40  and endoscope probe  30  to be advanced along the guide  25  and patient&#39;s airway as a single assembly.  
      The shape of the guide  25 , the support member  131 , and laryngeal mask  130  tend to align the distal opening of the guide  25  with the larynx  18  so that the endoscope probe  30  and endotracheal tube  40  will pass through the opening between the vocal cords. However, after emerging from the distal end of the guide  25 , the direction of the distal tip of the endoscope probe  30  can be controlled by the physician. This allows the physician to carefully guide the endoscope probe  30  and endotracheal tube  40  to a position past the larynx  18  while resuscitation continues. Many conventional endoscopes include a suction channel extending the length of the fiber optic probe to its distal tip. This feature can be used to suction mucus or other secretions from the patient&#39;s airway as the endoscope/endotracheal tube assembly is inserted. Alternatively, an endoscope  30  may not be needed at all due to the anatomical alignment provided by the laryngeal mask  130 , which permits “blind” intubation of the patient. In any event, the patient is being ventilated and can receive cardiac chest compressions throughout the intubation process, so the normal risks associated with intubation are not as serious if delays are encountered in completing the intubation process using the present invention.  
      In one methodology, the endoscope probe  30  is then removed from within the endotracheal tube  40 , as shown in  FIG. 37 . The laryngeal mask  130  is deflated and the guide  25  is removed while leaving the endotracheal tube  40  in place within the trachea, as illustrated in  FIG. 38 . Alternatively, the guide  25  can be left in place to serve as an oral airway and to protect the endotracheal tube  40  from being bitten by the patient&#39;s teeth. However, the laryngeal mask  130  should be deflated if the device is to be left in place in the patient&#39;s airway for an extended period time to minimize damage to the mucous lining.  
      The cuff  44  on the endotracheal tube  40  is then inflated via an inflation tube and port valve  45 . Finally, a ventilator  50  is connected to the proximal end of the endotracheal tube  40  to ventilate the patient, as shown in  FIG. 39 . Alternatively, the patient can be manually ventilated by connecting a resuscitation bag to the proximal end of the endotracheal tube  40 .  
       FIG. 40  depicts an alternative methodology in which the guide,  25  is withdrawn over the endoscope probe  30  while leaving the endotracheal tube  40  in place in the patient&#39;s airway. In this methodology, after the endotracheal tube  40  has been moved into position with its distal end in the trachea as illustrated in  17 , the laryngeal mask  130  is deflated and the guide  25  is removed over the proximal end of the endotracheal tube  40  while leaving the endotracheal tube  40  and fiber optic probe  30  in place. Before removing the guide  25 , the healthcare provider may wish to slide the stabilizer  120  a few centimeters toward the distal end of the fiber optic probe  30 . This allows the endoscope  30  to be pulled back relative to the endotracheal tube  40 , so that the distal tip of the endoscope  30  is located within the distal end of the endotracheal tube  40  and offers a view of both the endotracheal tube&#39;s distal tip and the patient&#39;s trachea. This enables the healthcare provider to monitor the position of the endotracheal tube  40  relative to the trachea as the guide  25  is removed, as described above.  
      The fiber optic probe  30  is then withdrawn from within the endotracheal tube  40  and the endotracheal tube cap  125  is removed if one is present. Finally, the patient can be ventilated via a conventional ventilator  50  connected to the endotracheal tube  40 , as shown in  FIG. 39 .  
      The above disclosure sets forth a number of embodiments of the present invention. Other arrangements or embodiments, not precisely set forth, could be practiced under the teachings of the present invention and as set forth in the following claims.