Keep Breathing: Avoiding Hypoxia with the McMurray Enhanced Airway (MEA) with Roxanne McMurray and Noah Hendler: Audio automatically transcribed by Sonix

Keep Breathing: Avoiding Hypoxia with the McMurray Enhanced Airway (MEA) with Roxanne McMurray and Noah Hendler: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Saul Marquez:
Hey everybody, Saul Marquez with the Outcomes Rocket, thanks so much for tuning in again. Today, I have two magnificent nurse leaders with us. First, I’ve got Roxanne McMurray. She has been a nurse for thirty-five years and practicing anesthesia around 30. She is the inventor of the McMurray Enhanced Airway and also the co-founder of McMurray Medical Group. McMurray is a retired Clinical Assistant Professor and Assistant Program Director in the Nurse Anesthesia Program in the Graduate School of Nursing at the University of Minnesota. I also have on the podcast today Noah Hendler. He is a nurse practitioner, health care technologist, and strategist who helped pioneer value-based episodic care models initiating some of the nation’s first bundled payment programs. He served on the front lines and busy urban trauma centers, lead clinical informatics, work through post-acute settings and help deliver new levels of transparency for both medication, reconciliation, and adherence. Noah is a co-founder of SONSIEL, and Roxanne is also very involved in the organization. And today I am just privileged to have both of you on the podcast. Welcome.

Noah Hendler:
Thanks, Saul.

Roxanne McMurray:
Thank you.

Saul Marquez:
It’s a pleasure to have you both. Nurses are at the center of everything we do. This campaign has been such an education for me and I know for the listeners, too. Over 50 percent of the care provided to everyone is from a nurse. COVID shots are coming from nurses. You guys are so important and we appreciate and love and value, I want to start by saying that I also want to know what is it that inspires you in this work? So go ahead, let us know what that is.

Noah Hendler:
Well, thanks again, Saul. So I think it’s important to underscore your point that nurses really are the largest workforce in health care, and that’s something that is overlooked and something that has definitely become central to my own work. I entered health care as a second career after the death of a good friend. When he died so did a part of me really. I felt the drift and nothing really seemed to mean much. And I kind of drifted further away from where I began my career working directly with people and actually photographing. I lived in Rwanda, worked with kids who are survivors of the genocide. And, you know, I had some success developing software, but in the wake of my friend’s death, I just felt like I needed to contribute in a more direct way. I didn’t really know how to do so. And the most direct contributors I knew were the nurses who touched the lives of my friend. And I realized that I was more like them than anyone else I knew. And I really like to care for people. At that time, my friends, my family didn’t know where the hell I want to become. Another statistic, college or soccer after that affects character and parents because to me it’s this rare breed of a male nurse. So they couldn’t grasp why I wanted to enter the profession and I was just determined to do so. And I was used to forging my own career path. And ultimately I enrolled in an accelerated BSN program, became a nurse practitioner. I’ve helped start and scale health care companies. I built products, have led innovation. Yet way too often I found myself the only nurse in a room filled with people trying to improve health care and overtime seeing the positive engagement with nurses within the larger context of health care innovation really made me committed to making sure more nurses see themselves as belonging at the forefront of health care innovation. And today, I couldn’t be more thrilled to be here with Roxanne McMurray, who has created an incredibly innovative McMurry Enhanced Airway. And her efforts and her journey as the nurse innovator is really emblematic of the kind of innovation that all nurses can bring to the table. And what’s crucial is that more nurses get a seat at the table to bring innovations to market. And that’s really, I think, important to underscore as we engage in an understanding and contribution. So I’d love to hear more about that.

Saul Marquez:
We’ll welcome Noah and thanks for sharing your story. Roxanne, tell us what inspires your work.

Roxanne McMurray:
Saul, thank you all for having me. And thank you to the listeners for joining us as well to learn more about how to improve airway management for our patients. What inspires me is to improve outcomes for patients, along with improving outcomes for the facility and providers as well, and to provide compassionate care. And as a practice, the Advanced Practice Nurse Anesthetists APRA and we’re also known as Certified Registered Nurse Anesthetist or CRNA. And to give you a brief background on what CRNA’s do since we know that we’re the best-kept secret profession, we practice independently as the anesthesia provider or in tandem with anesthesiologists. And from my vantage point on health care, it comes with great responsibility. My job is to keep patients safe. We keep them alive and comfortable during surgical procedures. And I’m inspired in health care by the opportunity to care for patients and to give back.

Roxanne McMurray:
In 2004, I took my first medical mission trip to Lima, Peru, and I went with a team of clinicians and plastic surgeons, primarily to fix cleft lip and palates in children. As a nurse anesthetist, my role was to provide anesthesia. And that first trip really had a profound impact on me and the practice. And I participated in several more.

Roxanne McMurray:
On one of these trips. I cared for a young boy with a cleft palate and nearly full-weight fused lips, like seventy-five percent of his lips were fused o you can imagine that he could hardly eat and he was malnourished and the surgeon needed to do a two-step process for this procedure. He needed to open up his lips first before we could fix this cleft palate. But because of his anatomy, the traditional airway management options were very, very limited. I had to create a tool to keep the boy comfortable and safe. So taking the boy’s airway into consideration, necessity was the mother of invention. As I improvised an airway management approach that would work using the limited supplies that I had on hand at this facility in Lima, Peru. And my solution enabled me to open the boy’s airway during deep sedation, also known as monitored anesthesia care or MAC so if you hear me say deep sedation or MAC, they are synonymous. And this tool that I created was crafted to supply oxygen closer to his lungs while avoiding chin lift and jaw thrust what sometimes we have to do to keep the airway open under sedation. And so this tool also allows me to keep my hands out of the surgical field and reduce oxygen diffusion around that surgical area which minimizes the risk. So you can imagine surgeons working in that area around the time they are trying to keep his airway open. But this to allow me not to be so close to the surgeon and then having cautery for the surgeon along with oxygen, that is just something waiting for disaster to happen. So this tool allowed us to minimize that risk. So through that ingenuity, we were able to proceed to that general anesthetic after opening his lips to intubate the patient and then complete that second surgery to close this pallet. So it was helping this Peruvian boy that the idea for the McMurray Enhanced Airway, also known as the MEA was Born. And that experience created a better solution for Him and helped me understand how I could improve our management for others to back here in the United States. And I realized how much my colleagues and I were often settling for subpar tools instead of creating better ones to meet the demands of our populations and our practice.

Speaker4:
So over my career, I’ve seen the prevalence of complicated airways increasing alongside higher rates of obesity and sleep apnea. Yet rather than creating better tools, most routinely we settle for the status quo and assemble our own workarounds to keep that airway open and not seeing others take initiative to create a better tool. I leverage the support of my family, my friends, countless hours outside of my day job, and invested my own money to design the McMurray Enhanced Airway or MEA. And this new airway is similar to the one that I created for the Peruvian boy, supplies oxygen closer to the lungs while avoiding the chin lift or jaw thrust, frees up our hands to tend to other important tasks in the operating room, reduces that oxygen diffusion around that surgical area to minimize the fire risk, and then also can improve to further simplify positive pressure, mass ventilation and breathing for our patients by providing intraoral ventilation.

Saul Marquez:
Well, that’s a great story. And in those times of need, I mean, you’re in this situation in Peru where you didn’t have much to work with, but you had this need and you said there’s a way to get it done. There are so many examples of nurses doing this. But Roxanne, you did it in such a way that… It wasn’t enough, right? You didn’t just want to do it well in Peru. You came back home and you said we got to do more. It’s not acceptable to just stand here and make our hacks to make things work. And so you paved the way to make this happen. Huge kudos to you for that work. And now all the nurse anesthetists using this can benefit from that.

Noah Hendler:
Not just the nurse anesthetists, the emergency service personnel, anesthesiologists. And Roxanne’s contribution is really going across multiple domains. And I think you’re right, Saul. There’s really no other profession that’s more aware of the challenges in health care than the nurses. Fundamentally just being the largest segment of the health care workforce means nurses are on the front line of patient care and they carry this knowledge. It’s only gained by the day-to-day responsibility and in anesthesiology in particular. Most of the, correct me If I’m wrong Roxanne, but most anesthesia in the US is delivered by nurse anesthetists. Correct?

Roxanne McMurray:
That’s correct. Especially in the rural communities and the underserved areas.

Noah Hendler:
So having that kind of really being so focused on doing so many procedures and being with so many patients and seeing the change in the population as Roxanne alluded to it in terms of the increase in rates of obesity and the dynamics shifting. She, like many other nurses, is incredibly well-positioned to come up with solutions. And she’s really forging ahead as a nurse and making ground for others to follow. I just want to thank you for that tip.

Saul Marquez:
Yeah. For sure. It’s a fantastic work. I appreciate how we started today’s podcast, just level setting a little bit on what is CRNA and there’s this conception that a nurse, there’s this just one job and you sit at the bedside. But there are so many different types of nurses. Today we’re reviewing CRNA’s and the work of innovation that’s possible. And so what do you believe that people need to know that they don’t know about the role of nursing in improving outcomes?

Noah Hendler:
That’s a great question. I think that you alluded to some of it when you were trying to clarify the extensive role of nursing within health care delivery. You can’t have an engagement with a delivery system without encountering a nurse. Nurses are pervasive throughout health care delivery. There’s the Gallup poll that says nurses are the most trusted professionals time and time again. I think that trust is there in part because of our exposure to people at times of great vulnerability throughout these delivery systems. I think that it really underscores the imperative for nurses to be trusted to not only respond to problems but to create solutions as well as Roxanne has done.

Roxanne McMurray:
Yes, I agree with that. We’re in every aspect of the care for the patient and we deliver compassionate care to patients. We understand what they’re going through. We have the time, the ability to get to know our patients a little bit better than maybe our physician counterparts.

Saul Marquez:
Yeah, and it’s fantastic the work that’s being done. And Roxanne, you mentioned most of the anesthesia delivered is through nurses, and I didn’t know that. I’m wondering if you’re listening to this, did you know that? If you didn’t, this is awesome. And number one, a career opportunity that maybe you may consider because it’s a different approach to nursing. And number two, think you’re a nurse in a different way because he or she is probably the one that is the one that delivered the care. So just a great opportunity. And Noah I love that you’re here because you’re a male nurse. And this conception it’s all-female nurses. No, there are male nurses doing awesome stuff in the space. And so talk to us about an example of when you saw your nursing team provide a great solution to a problem.

Noah Hendler:
Roxanne, why don’t you take up that question?

Roxanne McMurray:
Well, the problem that I saw with developing the McMurry Enhanced Airway is that the tools that we have to open the airway, the nasal airway, the oral airway are not sufficient enough because they only go to the back of the tongue causing an increase in close glands, malpractice suits. And so we’re getting creative, trying to figure out, like I did in Peru, to open the airway. And our patients have changed over the last hundred years. And oral airway in the nasal airways was developed in the 1920s. And it’s like we need a better solution because we’re having issues with this. We need to lifting the chin and doing a chin lift and jaw thrusts to the point that postoperatively our patients are complaining more of their chin and hurting and even dislocated chin more so than there are surgical incisions. And our hands are being occupied during that process as well. So we need to free our hands to do other important tasks. But yet we want our patients to breathe so creating the McMurry Enhanced Airway, the MEA to open the distal tissue beyond the base of the tongue is needed. It’s another tool that we can use because that redundant tissue with the patients that are aging, history of obesity, sleep apnea and also patients with beards, which are pretty popular with COVID, is that we need airway tools that can open the airway and also provide ventilation for our patients.

Roxanne McMurray:
Now, this morning, I read in a journal article from Anesthesiology news that there was this gentleman who was having a procedure and he was not the healthiest man who was in his 50s. And he was morbidly obese and he had some airway issues under sedation during his procedure, but they were rectified. But when the procedure was over and they turned them back on his back, he wasn’t breathing. It was APNIC. And they try to ventilate for him and they try to intubate. And two weeks later, he passed away. And it’s like this shouldn’t happen. This is all preventable. We just need better tools in our toolbox to help people like this.

Saul Marquez:
Yeah, Roxanne, great story. And I mean, one hundred years ago, this thing was developed one hundred years ago. Give us something better. And I love that you said I don’t have to put up with this. I’m going to put my own money on the line and I’m going to raise funds, get support. And here we are with a tool that’s making a difference. This is a great example.

Roxanne McMurray:
And the other thing is that outpatient surgery procedures are on the rise in the United States and is expected to be about one hundred and forty-four million in the year 2023. Procedures are going to be in the outpatient setting, also in ambulatory surgery centers. So we’re trying to move procedures out of the hospital, out of the main operating room into procedure centers and outpatient surgery centers. And the reason for that is that it’s more attractive, it’s more cost-effective, more organize and time-efficiency. And the patients don’t have to stay overnight. It’s a win-win for cost savings as well for the patient.

Saul Marquez:
What an amazing solution, especially as we do transition to more ambulatory care for the procedures really around the idea of setbacks. It’s something that I feel like we learn a lot from. It’d be great to hear from one of you really about a setback you’ve had and maybe a key learning that came out of it.

Noah Hendler:
I think that for me, it was an initial setback I had coming into the profession as a later career nurse, someone who had expertise in technology and business before going into health care. I was working as a staff nurse in the emergency department and I was new to health care. I’ve tried to maintain that perspective throughout my career, but being new to health care and being immersed in a busy emergency department, it was very easy to see a lot of jobs and holes and opportunities for improvement, particularly in the way handoffs were done and watching the hospitals take all my efforts to package up this patient and as they’re admitted to the emergency department and really lose a lot of sentiment and crucial points in this kind of game of telephone that we would play, we’d hand off patients was really frustrating to me. So I prototyped the software to do as per handoffs. And then I went to go show that piece of software to the hospital and they pretty much dismissed me offhand as like, why are you showing us this? Like, you’re just a nurse. And they didn’t know anything about my previous success or what I accomplished. And I just was kind of flabbergasted by that being dismissed out of hand and realized it would take me a little bit longer to get to where I thought it should be within the health care. And that’s in part what led me to co-found SONSIEL and work with an incredible cohort of nurses really internationally to create opportunities for more nurses to be innovative through our hackathon and through all of the SONSIEL initiatives and the partnership with Microsoft and Johnson&Johnson as well. Also led me to co-founders, which is the first and only comprehensive platform for third-party expert evaluation and validation, where we certify solutions that nurses consider necessary and trustworthy. And I really feel like those setbacks helped help me ultimately leverage my impact and get more nurses to bring solutions forward like Roxanne as well as others I’ve been working with through Johnson&Johnson, we helped them launch a fellowship for nurse innovation. And I can tell you that those 12 fellows that Johnson & Johnson are doing incredible things, just like Roxanna’s new airway is really forging new ground for airway management. There are so many examples of nurses who are facing problems and really being on the front lines of saying, like, I don’t want to settle for the status quo. This can be much better. I think Roxanne should share some of her own setback was and what led her in this direction and how difficult it’s been to change management in health care and push for solutions forward.

Saul Marquez:
Thank you, Noah. Yeah, great share, by the way. I mean, to get that reception, you’re just the nurse, I’m sure was very discouraging. And it was the fire that kind of lit to do the work that you all are working on. Just very nice to hear. Roxanne, you’re going to tell us yours.

Roxanne McMurray:
Yes. And I had a setback several times. But in 2014, I was awarded a patent for the McMurry Enhanced Airway. And of course, the patent doesn’t mean much unless you do something with it. And as a faculty at the University of Minnesota at that time, I signed my issued patent over to the Office of Commercialization, the OTC Department in hopes that they would help bring it to market structure, they have the resources, they have the money to bring this to market and to do something with it. However, after two years, there was little progress and I understood that signing over my patent was not enough. So I had them sign that back to me. And at that time, I really didn’t have an idea how to bring the patent to manufacture and to start selling it. But at that same time, fortuitously around, my husband was in a golf tournament with this gentleman and shared a golf cart with them. And he is now our co-founder of McMurry Medical and he has the manufacturing background and has the business knowledge to bring the MEA to fruition.

Saul Marquez:
That’s amazing. I got that patent back in your name and all these things are amazing. Right? So it sat there for two years and you’re like, OK. This isn’t going anywhere, give it back to me and it just so happened through your husband, find somebody that’s in manufacturing and here you guys are in business. I mean, I just love that. That’s a phenomenal story. And I really love your persistence, Roxanne, and making that happen. Right. you didn’t want to let them fall. You wanted to see it succeed. And so today it’s a product available to everyone?

Roxanne McMurray:
So in 2016, we formed Mcmurry Medical and started manufacturing. And then in August of 2019, we started selling, which was on the up and up until COVID hit. So its sales slowed down a little bit. But sales are still moving upward and the MEA is now having ongoing sales in 24 states and we’re being used throughout major academic medical centers, surgical centers, and emergency medical services. And it’s interesting to hear some of the feedback from my colleagues that have used it. And some of the comments are it’s a game-changer. It’s like I keep one in my pocket. Why didn’t I think about that? So those are the comments that really keep me motivated. And to know that the MEA is a positive solution to open the airway and a tool that we can put in our toolbox.

Saul Marquez:
That’s awesome. That is so great. Congratulations on that. I mean, it’s just a huge win, a huge win for anybody managing the airway and for nurses’ innovation. So love that you shared that with us today. What are you both most excited about today?

Roxanne McMurray:
I’m excited when I hear the stories of my colleagues around the US and how the AMA has kept their patients breathing and alive. Like a couple of weeks ago, I heard from my colleague and Hilton Head and she said I went to the ICU. The patient that I saw his oxygen saturations were in the fifties. And I knew that we had to intervene, but I was by myself. So I pulled the MEA out of my pocket. I put it in his mouth. It was easy. Popped his oxygen saturation back up in the nineties and They were able to take their time to secure that airway and to activate that patient. So stories like that get me excited and make it all worthwhile.

Saul Marquez:
That’s awesome.

Roxanne McMurray:
It is. It’s incredible. And for me, I just am excited when nurses get what they need because we all benefit. We really do. And it’s just unfortunate far too often still that nurses aren’t –. As we’ve discussed already during the nurses, the largest global health care workforce is the backbone of health care systems, the infrastructure is really worldwide. So having the opportunity to purpose-built, to serve, to test, support, promote quality health care innovations from those who are on the front lines of health care is really something that’s mutually beneficial. And that means that we’re often excited by all the things I know that are in the pipeline from the position I’m in. I know so many nurse innovators, patient gowns are being redesigned by one of the fellows we have. There’s a nurse-led company that came out of one of the SONSIEL’s associates hackathon that’s made it a new kind of flashlight that nurses can wear when they enter the patient room so they don’t disrupt patients during the night, which is quite remarkable because half the nursing workforce works at night, and yet no one has ever given them a flashlight before. I think that kind of tells you how low the bar is for some innovation, let alone the high bar that Roxana has reached for by creating a new methodology that really improves their right management for an incredibly vulnerable population and an increasing cross-section of the population. So there’s a lot that nurses can contribute. And I’m excited they’re getting to contribute for more.

Saul Marquez:
Yeah, that’s for sure. The opportunities are endless and the call to action is to recognize everybody listening, recognize that nurse innovation is game-changing. And if this series hasn’t taught you that, definitely go relisten because there’s tons of great value. And today we’ve got Roxanne and Noah telling us even more examples about how we could listen to nurses in the innovation process, in the writing of protocols, you name it. There’s an opportunity to get better. And if you happen to be dealing with pharyngeal tissue beyond the tongue, there is the Mcmurray Enhanced Airway. Those pesky airways don’t have to bother you, thanks to Roxanne and her persistence. So we’re getting to the end here. I’ve had so much fun. This has been so interesting. Give us a closing thought. I’d love to hear one from both of you. And then the best place for the listeners could get in touch with you and learn more. Obviously, outside of the SONSIEL, which everybody knows where to go, they’ll find you there. But outside of that where can they learn from you?

Roxanne McMurray:
My closing thoughts are as outpatient procedures increase in number, so is back and deep sedation, anesthesia. And we really need airway management tools in our disposable hearts and in our bags to keep that airway open at a moment’s notice and to keep our patients breathing and along with EMS and first responders that also do airway management and have a harder time for mass ventilation, which is actually more challenging than intubation. The MEA is also handy for that as well, providing intraoral ventilation. And we need to keep our patients breathing and we need to address the gap in airway management. So I invite you to go to Mcmurraymed.com, our website, or also contact me, Roxanne McMurray on LinkedIn to find out more information about McMurray enhanced airway and how we can keep them breathing.

Saul Marquez:
Love it. Thank you, Roxanne. Noah.

Noah Hendler:
I think that it’s valuable to reflect on how nurses really are the most trusted professionals for more than two decades and that the opinions of nurses on products that you use for patient care is at the center of health care innovation, let alone the ones they create, like Roxanne and her incredible airway and all the benefits that people can find out more about me and about nurses proof that nurse improves health, where we’re really focused on accelerating valuable connections between this kind of high impact patient solutions and the nurses who drive health care transformation.

Saul Marquez:
Awesome.

Roxanne McMurray:
And I’m grateful for Noah, for SONSIEL and for nurse approved, for being nurses that are allies and helping to move innovation forward. I’m grateful for them to have that sisterhood and that brotherhood just come alongside you and to help you with your innovation.

Saul Marquez:
Great call, Roxanne, and just the recognition to all the amazing people and organizations pushing forward. And I think both of you, Roxanne, Noah for spending time with us today. Keep doing what you’re doing. We really appreciate you. Thanks so much, Saul.

Noah Hendler:
We love the podcast.

Roxanne McMurray:
Thank you, Saul, for this time.

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