Details

Autor(en) / Beteiligte

• Heard, Andrew
• Gordon, Helen
• Douglas, Scott
• Grainger, Nicholas
• Avis, Hans
• Vlaskovsky, Philip
• Toner, Andrew
• Thomas, Betty
• Kennedy, Chris
• Perlman, Hannah
• Fox, Joanna
• Tarrant, Kelly
• De Silva, Natasha
• Eakins, Patrick
• Patel, Prabir
• Fitzpatrick, Samuel
• Bright, Shona
• O'Keefe, Sinead
• Do, Thy
• Staff, Veterinary

Titel

Front-of-neck airway rescue with impalpable anatomy during a simulated cannot intubate, cannot oxygenate scenario: scalpel–finger–cannula versus scalpel–finger–bougie in a sheep model

Ist Teil von

• British journal of anaesthesia : BJA, 2020-08, Vol.125 (2), p.184-191

Ort / Verlag

England: Elsevier Ltd

Erscheinungsjahr

2020

Link zum Volltext

Quelle

Alma/SFX Local Collection

Beschreibungen/Notizen

• Front-of-neck airway rescue in a cannot intubate, cannot oxygenate (CICO) scenario with impalpable anatomy is particularly challenging. Several techniques have been described based on a midline vertical neck incision with subsequent finger dissection, followed by either a cannula or scalpel puncture of the now palpated airway. We explored whether the speed of rescue oxygenation differs between these techniques. In a high-fidelity simulation of a CICO scenario in anaesthetised Merino sheep with impalpable front-of-neck anatomy, 35 consecutive eligible participants undergoing airway training performed scalpel–finger–cannula and scalpel–finger–bougie in a random order. The primary outcome was time from airway palpation to first oxygen delivery. Data, were analysed with Cox proportional hazards. Scalpel–finger–cannula was associated with shorter time to first oxygen delivery on univariate (hazard ratio [HR]=11.37; 95% confidence interval [CI], 5.14–25.13; P<0.001) and multivariate (HR=8.87; 95% CI, 4.31–18.18; P<0.001) analyses. In the multivariable model, consultant grade was also associated with quicker first oxygen delivery compared with registrar grade (HR=3.28; 95% CI, 1.36–7.95; P=0.008). With scalpel–finger–cannula, successful oxygen delivery within 3 min of CICO declaration and ≤2 attempts was more frequent; 97% vs 63%, P<0.001. In analyses of successful cases only, scalpel–finger–cannula resulted in earlier improvement in arterial oxygen saturations (–25 s; 95% CI, –35 to –15; P<0.001), but a longer time to first capnography reading (+89 s; 95% CI, 69 to 110; P<0.001). No major complications occurred in either arm. The scalpel–finger–cannula technique was associated with superior oxygen delivery performance during a simulated CICO scenario in sheep with impalpable front-of-neck anatomy.