Time to oxygenation for cannula‐ and scalpel‐based techniques for emergency front‐of‐neck access: a wet lab simulation using an ovine model

Rees, Kim; O'Halloran, L.; Wawryk, J.; Gotmaker, Robert; Cameron, E.; Woonton, H.

doi:10.1111/anae.14706

Cited by 23 publications

(36 citation statements)

References 20 publications

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“…Consistent with the findings in the´wet´sheep model of morbidly obese neck, we have not observed any differences in insertion times between the cannula and scalpel-bougie technique [25]. However, when compared to the non-obese or slim-neck animal models, longer insertion times were reported especially for cannula technique [2,13,16,[25][26][27]. In our study, the cannula technique was successfully accomplished in less than 60 seconds in only three animals (27%)…”

Section: Plos Onesupporting

confidence: 89%

“…Using a novel cricothyroidotomy introducer invented to slide the bougie into the trachea may be of assistance in this case [26]. Our findings are therefore in contradiction to those obtained in a slim neck ovine model [16] suggesting that the pre-tracheal tissue thickness needs to be taken into consideration when deciding on the optimal eFONA technique in the patient [5].…”

Section: Plos Onecontrasting

confidence: 78%

“…The NAP4 specifically noted a high failure rate (63%) of cannula technique, mainly attributed to neck positioning, obesity, poor insertion technique, incorrect cannula ventilation method and inadequate training [13][14][15]. Nevertheless, when performed in a wet lab simulation using an ovine model [16], the cannula technique proved advantageous compared to the scalpel technique. Thus, given the potential impact of the thickness of the pretracheal tissue on the success of the particular eFONA technique, we set up the study using an anesthetized porcine model to compare the cannula and the scalpel-bougie techniques using the success rate of rescue oxygenation as the primary outcome measure.…”

Section: Introductionmentioning

confidence: 99%

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Rescue oxygenation success by cannula or scalpel-bougie emergency front-of-neck access in an anaesthetised porcine model

et al. 2020

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In the obese, the evidence for the choice of the optimal emergency front-of-neck access technique is very limited and conflicting. We compared cannula and scalpel-bougie emergency front-of-neck access techniques in an anaesthetised porcine model with thick pretracheal tissue. Cannula and scalpel-bougie cricothyroidotomy techniques were performed in 11 and 12 anaesthetised pigs, respectively. Following successful tracheal access, oxygenation was commenced and continued for 5 min using Rapid-O2 device for cannula and circle breathing system for scalpel-bougie study groups. The primary outcome was a successful rescue oxygenation determined by maintenance of arterial oxygen saturation >90% 5 min after the beginning of oxygenation. Secondary outcomes included success rate of airway device placement, time to successful airway device placement, and trauma to the neck and airway. The success rate of rescue oxygenation was 18% after cannula, and 83% after scalpel-bougie technique (P = 0.003). The success rate of airway device placement was 73% with cannula and 92% with scalpel-bougie technique (P = 0.317). Median (inter-quartilerange) times to successful airway device placement were 108 (30-256) and 90 (63-188) seconds (P = 0.762) for cannula and scalpel-bougie emergency front-of-neck access, respectively. Proportion of animals with iatrogenic trauma additional to the procedure itself was 27% for cannula and 75% for scalpel-bougie technique (P = 0.039). Thus, in the porcine model of obesity, the scalpel-bougie technique was more successful in establishing and maintaining rescue oxygenation than cannula-based technique; however, it was associated with a higher risk of severe trauma.

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