Journal article
Cannula cricothyroidotomy in the impalpable neck: An observational study of simulated ‘can’t intubate, can’t oxygenate’ scenarios by teams following a cannula-first algorithm in live anaesthetised pigs
Anaesthesia and Intensive Care
2022
Abstract
Live animal models can be used to train anaesthetists to perform emergency front-of-neck-access. Cannula cricothyroidotomy success reported in previous wet lab studies contradicts human clinical data. This prospective, observational study reports success of a cannula-first ‘can't intubate, can't oxygenate’ algorithm for impalpable anatomy during high fidelity team simulations using live, anaesthetised pigs.
Forty-two trained anaesthesia teams were instructed to follow the Royal Perth Hospital can't intubate, can't oxygenate algorithm to re-oxygenate a desaturating pig with impalpable neck anatomy (mean (standard deviation, SD) 16.2 (3.5) kg); mean (SD) tracheal internal diameter 11 (1.4) mm. Teams were informed that failure would prompt veterinary-led euthanasia.
All teams performed percutaneous cannula cricothyroidotomy as the initial technique, with a median (interquartile range, IQR (range)) start time of 42 (35–50 (24–93)) s. First-pass percutaneous cannula success was 29% to both insufflate tracheal oxygen and re-oxygenate. Insufflation success improved with repeated percutaneous attempts (up to three), but prolonged hypoxia time increasingly necessitated euthanasia (insufflation 57%; re-oxygenation 48%). First, second and third percutaneous attempts achieved insufflation at median (IQR (range)) 74 (64–91 (46–110)) s, 111 (95–136 (79–150)) s and 141 (127–159 (122–179)) s, respectively. Eighteen teams failed with percutaneous cannulae and performed scalpel techniques, predominantly dissection cannulation (n = 17) which achieved insufflation in all cases (insufflation 100%; re-oxygenation 47%). Scalpel attempts were started at median (IQR (range)) 142 (133–218 (97–293)) s and achieved insufflation at 232 (205–303 (152–344)) s.
While percutaneous cannula cricothyroidotomy could rapidly re-oxygenate, the success rate was low and teams repeated attempts beyond the recommended 60 s time frame, delaying transition to the more successful dissection cannula technique. We recommend this ‘cannula-first’ can't intubate, can't oxygenate algorithm adopts a ‘single best effort’ strategy for percutaneous cannula, with failure prompting a scalpel technique.
Details
- Title
- Cannula cricothyroidotomy in the impalpable neck: An observational study of simulated ‘can’t intubate, can’t oxygenate’ scenarios by teams following a cannula-first algorithm in live anaesthetised pigs
- Authors/Creators
- A.S. Wycherley (Author/Creator) - Fiona Stanley HospitalE.M. Debenham (Author/Creator) - Fiona Stanley HospitalE. O’Loughlin (Author/Creator)J.R. Anderson (Author/Creator) - Fiona Stanley HospitalF.R. Syed (Author/Creator) - Fiona Stanley HospitalA.L. Raisis (Author/Creator) - Murdoch University
- Publication Details
- Anaesthesia and Intensive Care
- Publisher
- Australian Society of Anaesthetists
- Identifiers
- 991005542346507891
- Copyright
- © 2022 by Australian Society of Anaesthetists
- Murdoch Affiliation
- School of Veterinary and Life Sciences
- Language
- English
- Resource Type
- Journal article
Metrics
104 Record Views
InCites Highlights
These are selected metrics from InCites Benchmarking & Analytics tool, related to this output
- Citation topics
- 1 Clinical & Life Sciences
- 1.235 Throat & Voice Disorders
- 1.235.847 Airway Management
- Web Of Science research areas
- Anesthesiology
- Critical Care Medicine
- ESI research areas
- Clinical Medicine