The ‘Can't Intubate Can't Oxygenate’ scenario in Pediatric Anesthesia: a comparison of different devices for needle cricothyroidotomy
Article first published online: 16 OCT 2012
© 2012 Blackwell Publishing Ltd
Volume 22, Issue 12, pages 1155–1158, December 2012
How to Cite
Stacey, J., Heard, A. M. B., Chapman, G., Wallace, C. J., Hegarty, M., Vijayasekaran, S., von Ungern-Sternberg, B. S. (2012), The ‘Can't Intubate Can't Oxygenate’ scenario in Pediatric Anesthesia: a comparison of different devices for needle cricothyroidotomy. Pediatric Anesthesia, 22: 1155–1158. doi: 10.1111/pan.12048
- Issue published online: 7 NOV 2012
- Article first published online: 16 OCT 2012
- Manuscript Accepted: 4 SEP 2012
- Princess Margaret Hospital Foundation
- difficult airway;
- animal model
Little evidence exists to guide the management of the ‘Can't Intubate, Can't Oxygenate’ (CICO) scenario in pediatric anesthesia.
To compare two intravenous cannulae for ease of use, success rate and complication rate in needle tracheotomy in a postmortem animal model of the infant airway, and trial a commercially available device using the same model.
Two experienced proceduralists repeatedly attempted cannula tracheotomy in five postmortem rabbits, alternately using 18-gauge (18G) and 14-gauge (14G) BD Insyte™ cannulae (BD, Franklin Lakes, NJ, USA). Attempts began at the first tracheal cartilage, with subsequent attempts progressively more caudad. Success was defined as intratracheal cannula placement. In each rabbit, an attempt was then made by each proceduralist to perform a cannula tracheotomy using the Quicktrach Child™ device (VBM Medizintechnik GmbH, Sulz am Neckar, Germany).
The rabbit tracheas were of similar dimensions to a human infant. 60 attempts were made at cannula tracheotomy, yielding a 60% success rate. There was no significant difference in success rate, ease of use, or complication rate between cannulae of different gauge. Successful aspiration was highly predictive (positive predictive value 97%) and both sensitive (89%) and specific (96%) for tracheal cannulation. The posterior tracheal wall was perforated in 42% of tracheal punctures. None of 13 attempts using the Quicktrach Child™ were successful.
Cannula tracheotomy in a model comparable to the infant airway is difficult and not without complication. Cannulae of 14- and 18-gauge appear to offer similar performance. Successful aspiration is the key predictor of appropriate cannula placement. The Quicktrach Child was not used successfully in this model. Further work is required to compare possible management strategies for the CICO scenario.