Airway control via the Cobrapla™ during percutaneous dilatational tracheotomy in five patients

Abstract

P Pu ur rp po os se e: : To evaluate the use of the new supraglottic airway device CobraPLA™ (CPLA) for performing percutaneous dilatational tracheotomy (PDT) utilizing continuous fibreoptic visualization of the larynx and trachea and uninterrupted airway control.C Cl li in ni ic ca al l f fe ea at tu ur re es s: : The percutaneous tracheotomies were carried out in five patients (four males and one female; mean age 72 yr, mean height 164.6 cm, mean weight 74 kg) following the Griggs technique under continuous fibreoptic vision and airway control provided by the CPLA. The mean time required for removal of the ETT, positioning of the CPLA, and confirmation of adequate ventilation and cuff seal was 78 sec. The mean time for the entire PDT procedure was six minutes and 57 sec. In one patient a 7-mm tracheostomy cannula was used, and in the other four patients an 8-mm cannula was used.The hemodynamic and respiratory variables remained stable during the entire procedure; there were no adverse events.At no point was there any significant difficulty in placing the CPLA or in providing ventilation or oxygenation. Each procedure could be observed easily in its entirety through the FOB.

Brief review: The Cobra Perilaryngeal Airway (CobraPLA®) and the Streamlined Liner of Pharyngeal Airway (SLIPA™) supraglottic airways

“…19,21,22 Case reports and case series evaluating the CobraPLA® Hemodynamic and respiratory variables were reported to remain stable during insertion of the CobraPLA®, in two preliminary studies and cohort studies involving 34 cases. [23][24][25] The success of the CobraPLA®, in achieving effective ventilation, was reported in two cases of the LMA Classic™ failure in patients with head and neck burns, contractures, limited neck extension, and limited mouth opening. 26 Moreover, the CobraPLA® has been reported as being successful in the management of a difficult airway: in single cases of the Intubating LMA TM 's failure as a means of securing the airway; 27 for the difficult to intubate/ventilate scenario; 28 and in the airway management of a neonate with Desbuquois syndrome.…”

“…These reports suggest that the CobraPLA® may act as an alternative rescue airway in difficult airway scenarios. There are also reports describing successful maintenance of the airway with the CobraPLA®, during performance of percutaneous, dilatational tracheostomy 24,25 and percutaneous cricothyroidotomy/tracheostomy. 30,31 The CobraPLA® has successfully been used as a conduit for flexible bronchoscopy in a child under general anesthesia.…”

Cobra perilaryngeal airway for thyroid surgery in a hypertensive patient

“…The fi beroptic view of the vocal cords is better with the CobraPLA than with the LMA-Classic [5,8]. In our patient also, the vocal cords were easily visualized on fi beroptic bronchoscopy via the CobraPLA.…”

“…3 size) and wider-diameter stem [7]. The CobraPLA differs from the LMA-Classic in that it has a circumferential cuff that resides in the hypopharynx at the base of the tongue, as opposed to the LMA cuff, which lies immediately behind the cricoid cartilage and with which there is the possibility of cuff rupture during neck surgery [8].…”

Airway rescue using an “undersized” CobraPLA™ during cardiopulmonary resuscitation

“…Because neither of these devices was available, we chose a size #3 CobraPLA™ extraglottic airway. The CobraPLA™ is easy to insert and provides excellent ventilation in anesthetized patients, and it is an acceptable alternative to the LMA [4][5][6][7][8]. It has proven effective in other situations for management of difficult airways in anesthetized patients [9][10][11].…”