Cannot ventilate-cannot intubate an infant: Surgical tracheotomy or transtracheal cannula?

Karina Johansen (1) , Rolf Jens Holm-Knudsen (2) , Birgitte Charabi (3) , Michael Seltz Kristensen (2) , Lars Simon Rasmussen (2)

1 Anaesthesia, 4231
2 Anaesthesia, 4231
3 Head and Neck Surgery

Summary Background: An unanticipated difficult airway is very uncommon in infants. The recommendations for managing the can't ventilate-can't intubate ('CVCI') situation in infants and small children are based on difficult airway algorithms for adults. These algorithms usually recommend placement of a transtracheal cannula or performing a surgical tracheotomy as a last resort. In this study we compared the success rate and time used for inserting a transtracheal cannula versus performing a modified surgical tracheotomy in a piglet model. Methods: We used 10 three-weeks-old euthanized piglets, weighing eight kilograms each. Thirty physicians had a timed attempt of inserting a transtracheal cannula for jet ventilation. A maximum time of 120 sec was allowed. Ten physicians had a timed attempt of performing a modified surgical tracheotomy after a short introduction by an ENT surgeon. The allowed time for this procedure was 240 sec. Results: Placement of the transtracheal cannula was successful for 8 of30 physicians. Median time for successful insertion was 68 sec. Surgical tracheotomy was successful for 8 of 10 physicians. Median time for successful tracheotomy was 89 sec. There was a significantly higher success rate for surgical tracheotomy (P=0.007). Conclusions: We found placement of a transtracheal cannula to be significantly less successful than the modified surgical tracheotomy in a piglet model. We question if placement of a transtracheal cannula should be recommended in infants in a can't ventilate-can't intubate situation. Keywords: difficult airway; animal model; airway algorithm; emergency tracheotomy; children; transtracheal cannula.

Mots clés: Medicine

Karina Johansen, Rolf Jens Holm-Knudsen, Birgitte Charabi, Michael Seltz Kristensen, Lars Simon Rasmussen. Cannot ventilate-cannot intubate an infant: Surgical tracheotomy or transtracheal cannula?. Pediatric Anesthesia, 2010, 20 (11), pp.987. ⟨10.1111/j.1460-9592.2010.03417.x⟩. ⟨hal-00580705⟩