Emergency percutaneous transtracheal ventilation (PTV)

Pediatric transtracheal and cricothyrotomy airway devices for emergency use: which are appropriate for infants and children?

“…An alternative would be to leave the barrel of the 3-ml syringe attached to the intravenous catheter, insert an 8-mm endotracheal tube adapter to the syringe barrel, and then attach to a ventilating system with a standard 22-mm adapter. Note that in the neonate or infant the cricothyroid membrane is quite small its identification may be difficult because the thryroid cartilage and the hyoid bone are difficult to differentiate necessitating puncture of the trachea below the level of the cricothyroid membrane to successfully enter the trachea pneumomediastinum) (41,42,(42)(43)(44)(45). A commercially available device designed for low pressure jet ventilation is available (Enk Oxygen Flow Modulation set; Cook Inc, Bloomington, IN, USA) but a 'poor man's' version can be constructed by cutting a side hole in the oxygen tubing which is then intermittently occluded to divert flow into the catheter (Figure 4).…”

“…Alternatively, if the VBM device (or an i.v. catheter) is interfaced with a jet ventilation system, successful ventilation is achieved (being mindful that this must be tightly secured so as to not be propelled out of the airway thus causing massive and perhaps fatal subcutaneous emphysema or pneumomediastinum) (41,42,42–45). A commercially available device designed for low pressure jet ventilation is available (Enk Oxygen Flow Modulation set; Cook Inc, Bloomington, IN, USA) but a ‘poor man’s’ version can be constructed by cutting a side hole in the oxygen tubing which is then intermittently occluded to divert flow into the catheter (Figure 4).…”

A survey of surgical airway experiences and equipment among immediate care doctors

“…This may be through the creation of an orifice of some description in the oxygen tubing. Improvised injector systems have been shown to be efficacious in normoxic and hypoxic animals with normal12 – 15 and obstructed16 17 upper airways. There does not appear to be published evidence of the clinical efficacy of these devices.…”