Transtracheal jet ventilation in the ‘can’t intubate can’t oxygenate’ emergency: a systematic review

Duggan, Laura V.; Scott, Brooke Ballantyne; Law, J. Adam; Morris, Ian R.; Murphy, Michael; Griesdale, Donald

doi:10.1093/bja/aew192

Cited by 84 publications

(70 citation statements)

References 67 publications

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“…Repeated attempts of intubation may result in oedema of soft tissues and bleeding, which may lead to a vicious circle in which each subsequent intubation attempt intensifies the mentioned complications leading to the situation fIGuRe 5. First intubation success rate described by the Difficult Airway Society as 'Can't intubate, can't ventilate' [24,25]. Then the only possible salvation is cricothyroidotomy.…”

Section: Discussionmentioning

confidence: 99%

VivaSight single-lumen tube as an intubation method. A systematic review and meta-analysis of randomised simulation trials

Karczewska

Smereka

Dąbrowski

et al. 2020

Disaster Emerg Med J

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InTRoDuCTIon:Endotracheal intubation is one of the basic procedures performed in emergency medicine in patients with respiratory insufficiency, inability to maintain airway patency, or apnoea. Rapid performance of the procedure and implementation of ventilation are among the basic principles of rescue procedures. The primary aim of the present systematic review and meta-analysis was to compare the VivaSight single lumen (SL) tube-mounted camera with a standard endotracheal single-lumen tube and direct laryngoscope for endotracheal intubation based on randomised controlled trials of simulation or cadaver trials. The analysis was based on the hypothesis that the use of videolaryngoscopy based on VivaSight SL tube increases the effectiveness of endotracheal intubation, reducing the risk of ineffectiveness of the first intubation attempt and the risk of adverse events, such as dental compression. MATeRIAL AnD MeThoDS:We searched the MEDLINE, EMBASE, Scopus, Cochrane, and Google Scholar databases for randomised, controlled trials and observational studies from 1985 until October 2019, without language restrictions. Grey literature, clinicaltrials.gov, and reference lists of articles were hand searched. We conducted a meta-analysis with random-effects models to evaluate time to intubation, first-pass success rates, overall success rates, dental compression, and glottic view. ReSuLTS:The search located 12 eligible studies. The time of intubation using VivaSight was significantly shorter than that of direct laryngoscopy (MD = -11.29 [-13.10, -9.49], p < 0.001). The efficacy of the first intubation attempt was higher for VivaSight than for double lumen (DL) (96.0% vs. 61.7%; RR = 1.62 [1.40, 1.88], p < 0.001). The meta-analysis showed that the total efficacy of VivaSight intubation compared to direct laryngoscopy was statistically significantly higher (100% vs. 88.9%, RR = 1.11 [1.02, 1.20]; p = 0.02). The glottis visibility assessed as Cormack-Lehane grade I or II was better in VivaSight intubation compared to direct laryngoscopy (100% vs. 90.9%, RR = 1.05 [0.99, 1.12]; p = 0.08). ConCLuSIonS:Our meta-analysis suggests that the VivaSight SL provided better glottic visualisation and shorter intubation time, with improved success rates during different simulated intubation scenarios.

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Section: Discussionmentioning

confidence: 99%

VivaSight single-lumen tube as an intubation method. A systematic review and meta-analysis of randomised simulation trials

Karczewska

Smereka

Dąbrowski

et al. 2020

Disaster Emerg Med J

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“…Jet ventilation devices can deliver nearly 1 liter per second through a 14 gauge needle at 30 psi (2 atmospheres) and 1.25 liters per second at 50 psi (3.4 atm), and do so for as long as they are active. The main concern is that the continuous use of high driving pressures can easily traumatize the airway or cause pneumothorax …”

Section: Discussionmentioning

confidence: 99%

“…Jet ventilation [19][20][21][22][23][24][25][26] has been used more commonly in cases of upper airway obstruction to increase the time available for intubation. Gas is delivered at high pulse rates with low tidal volumes or low pulse rates with larger tidal volumes via rigid cannula that can be associated with a bronchoscope or laryngoscope, via cricothyroidotomy cannula, or introduced into a tracheal tube.…”

Section: Comparison With Transtracheal Insufflation and Jet Ventilationmentioning

confidence: 99%

A Resuscitation Option for Upper Airway Occlusion Based on Bolus Transtracheal Lung Inflation

Villiere

Nakase

Kollmar

et al. 2018

Laryngoscope Investig Oto

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BackgroundAcute laryngospasm sufficient to cause obstructive apnea is a medical emergency that can be difficult to manage within the very short time available for establishing an airway. We have presented substantial evidence that laryngospasm‐based obstructive apnea is the cause of sudden death in epilepsy, and airway management is particularly challenging during seizure activity.ObjectiveWe sought to determine if the transtracheal delivery of a bolus of oxygen or room air below the level of an obstruction to inflate the lungs could be an effective method to prolong the time available for responders seeking to establish a stable airway, and, if so, what could be learned about optimization of delivery parameters from a rat model.MethodsRats were fitted with a t‐shaped tracheal tube for controlling access to air and for measuring airway pressures. After respiratory arrest from simulated laryngospasm, bolus transtracheal lung inflation with a volume of gas equivalent to half the vital capacity was delivered to the closed respiratory system as the only resuscitation step.ResultsBolus lung inflation was sufficient for resuscitation, improving cardiac function and re‐establishing adequate oxygen status to support life. Inflation steps could be repeated and survival times were approximately 3 times that of non‐inflated lungs.ConclusionThe properties and consequences of bolus lung inflation are described as a foundation for procedures or devices that can be useful in cases of severe laryngospasm and other cases of upper airway obstruction.Level of Evidence3

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“…1 In addition, a systematic review of TTJV in a CICO situation highlighted a high incidence of failure (42%), complications (51%) and barotrauma (32%) with TTJV for narrow bore techniques. 18 A kink-resistant cannula should be used for narrow bore cricothyroidotomy. Narrow bore cricothyroidotomy does not provide a tracheal cuff and will thus require conversion to a more definitive airway to protect against aspiration and allow application of PEEP.…”

Section: Cannula Cricothyroidotomymentioning

confidence: 99%

Emergency front of neck access in airway management

Price

McCoy

2019

BJA Education

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Transtracheal jet ventilation in the ‘can’t intubate can’t oxygenate’ emergency: a systematic review

Abstract: TTJV is associated with a high risk of device failure and barotrauma in the CICO emergency. Guidelines and recommendations supporting the use of TTJV in CICO should be reconsidered.

Cited by 84 publications

References 67 publications

VivaSight single-lumen tube as an intubation method. A systematic review and meta-analysis of randomised simulation trials

VivaSight single-lumen tube as an intubation method. A systematic review and meta-analysis of randomised simulation trials

A Resuscitation Option for Upper Airway Occlusion Based on Bolus Transtracheal Lung Inflation

Emergency front of neck access in airway management

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