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Cannot ventilate-cannot intubate an infant: surgical tracheotomy or transtracheal cannula?
MedLine Citation:
PMID:  20880155     Owner:  NLM     Status:  In-Process    
BACKGROUND: An unanticipated difficult airway is very uncommon in infants. The recommendations for managing the cannot ventilate-cannot intubate (CVCI) situation in infants and small children are based on difficult airway algorithms for adults. These algorithms usually recommend placement of a transtracheal cannula or performing a surgical tracheotomy as a last resort. In this study, we compared the success rate and time used for inserting a transtracheal cannula vs performing a modified surgical tracheotomy in a piglet model.
METHODS: We used 10 three-week-old euthanized piglets, weighing eight kilograms each. Thirty physicians had a timed attempt of inserting a transtracheal cannula for jet ventilation. A maximum time of 120 s was allowed. Ten physicians had a timed attempt of performing a modified surgical tracheotomy after a short introduction by an ENT surgeon. The allowed time for this procedure was 240 s.
RESULTS: Placement of the transtracheal cannula was successful for eight of 30 physicians. Median time for successful insertion was 68 s. Surgical tracheotomy was successful for 8 of 10 physicians. Median time for successful tracheotomy was 89 s. There was a significantly higher success rate for surgical tracheotomy (P = 0.007).
CONCLUSIONS: We found placement of a transtracheal cannula to be significantly less successful than the modified surgical tracheotomy in a piglet model. We question whether placement of a transtracheal cannula should be recommended in infants in a cannot ventilate-cannot intubate situation.
Karina Johansen; Rolf J Holm-Knudsen; Birgitte Charabi; Michael S Kristensen; Lars Simon Rasmussen
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Publication Detail:
Type:  Journal Article     Date:  2010-09-29
Journal Detail:
Title:  Paediatric anaesthesia     Volume:  20     ISSN:  1460-9592     ISO Abbreviation:  Paediatr Anaesth     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-10-22     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9206575     Medline TA:  Paediatr Anaesth     Country:  France    
Other Details:
Languages:  eng     Pagination:  987-93     Citation Subset:  IM    
Copyright Information:
© 2010 Blackwell Publishing Ltd.
Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
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