Emergency airway access in children – transtracheal cannulas and tracheotomy assessed in a porcine model

Authors


Correspondence

Rolf Holm-Knudsen, Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark

Email: rolf.holm-knudsen@rh.regionh.dk

Summary

Objectives

In the rare scenario when it is impossible to oxygenate or intubate a child, no evidence exists on what strategy to follow.

Aim

The aim of this study was to compare the time and success rate when using two different transtracheal needle techniques and also to measure the success rate and time when performing an emergency tracheotomy in a piglet cadaver model.

Methods

In this randomized cross-over study, we included 32 anesthesiologists who each inserted two transtracheal cannulas (TTC) using a jet ventilation catheter and an intravenous catheter in a piglet model. Second, they performed an emergency tracheotomy. A maximum of 2 and 4 min were allowed for the procedures, respectively. The TTC procedures were recorded using a video scope.

Results

Placement of a transtracheal cannula was successful in 65.6% and 68.8% of the attempts (P = 0.76), and the median duration of the attempts was 69 and 42 s (P = 0.32), using the jet ventilation catheter and the intravenous catheter, respectively. Complications were frequent in both groups, especially perforation of the posterior tracheal wall. Performing an emergency tracheotomy was successful in 97%, in a median of 88 s.

Conclusions

In a piglet model, we found no significant difference in success rates or time to insert a jet ventilation cannula or an intravenous catheter transtracheally, but the incidence of complications was high. In the same model, we found a 97% success rate for performing an emergency tracheotomy within 4 min with a low rate of complications.

Ancillary