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Time to oxygenation for cannula‐ and scalpel‐based techniques for emergency front‐of‐neck access: a wet lab simulation using an ovine model
Author(s) -
Rees K. A.,
O'Halloran L. J.,
Wawryk J. B.,
Gotmaker R.,
Cameron E. K.,
Woonton H. D. J.
Publication year - 2019
Publication title -
anaesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.839
H-Index - 117
eISSN - 1365-2044
pISSN - 0003-2409
DOI - 10.1111/anae.14706
Subject(s) - medicine , cannula , oxygenation , anesthesia , surgery
Summary Emergency front‐of‐neck access to achieve a percutaneous airway can be a life‐saving intervention, but there is debate about the preferred technique. This prospective, observational study was designed to compare the two most common emergency surgical airway techniques in a wet lab simulation using an ovine model. Forty‐three doctors participated. After providing standardised reading, a lecture and dry lab benchtop training, participants progressed to a high‐fidelity wet lab simulation. Participants entered an operating theatre where a ‘cannot intubate, cannot oxygenate’ situation had been declared and were directed to perform emergency front‐of‐neck access: first with a cannula technique (14‐gauge cannula insertion with ventilation using a Rapid‐O2 ® cricothyroidotomy insufflation device); and subsequently, a scalpel‐bougie technique (surgical incision, bougie insertion into trachea and then tracheal tube passed over bougie, with ventilation using a self‐inflating bag). The primary end‐point was time from declaration of ‘cannot intubate, cannot oxygenate’ to delivery of oxygen via a correctly placed percutaneous device. If a cannula or tracheal tube was not placed within 240 s, the attempt was marked as a failure. There was one failure for the cannula approach and 15 for the scalpel‐bougie technique (OR 0.07 (95% CI 0.00–0.43); p <0.001). Median ( IQR [range]) time to oxygenation, if successful, was 65 (57–78 [28–160]) s for the cannula approach and 90 (74–115 [40–265]) s for the scalpel‐bougie technique (p=0.005). In this ovine model, emergency front‐of‐neck access using a cannula had a lower chance of failure and (when successful) shorter time to first oxygen delivery compared with a scalpel‐bougie technique.