The ‘Can't Intubate Can't Oxygenate’ scenario in pediatric anesthesia: a comparison of the Melker cricothyroidotomy kit with a scalpel bougie technique
| Autor: | Britta S. von Ungern-Sternberg, Gordon Chapman, Anoop Ramgolam, Shyan Vijayasekaran, Alberto Aranda-Palacios, Sarah L. Prunty, Mary Hegarty, A. M. B. Heard |
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| Rok vydání: | 2014 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Thyroid Gland Cricoid Cartilage Tracheotomy Bronchoscopy Infant airway Intubation Intratracheal Supine Position medicine Animals Humans Airway Management medicine.diagnostic_test business.industry Infant Newborn Oxygen Inhalation Therapy Infant Cannula Otorhinolaryngologic Surgical Procedures Surgery Anesthesiology and Pain Medicine Anesthesia Models Animal Pediatrics Perinatology and Child Health Rabbits Cadaveric spasm Complication business Airway Pediatric anesthesia |
| Zdroj: | Pediatric Anesthesia. 25:400-404 |
| ISSN: | 1155-5645 |
| DOI: | 10.1111/pan.12565 |
| Popis: | Summary Background While the majority of pediatric intubations are uncomplicated, the ‘Can't intubate, Can't Oxygenate’ scenario (CICO) does occur. With limited management guidelines available, CICO is still a challenge even to experienced pediatric anesthetists. Objectives To compare the COOK Melker cricothyroidotomy kit (CM) with a scalpel bougie (SB) technique for success rate and complication rate in a tracheotomy on a cadaveric ‘infant airway’ animal model. Methods Two experienced proceduralists repeatedly attempted tracheotomy in eight rabbits, alternately using CM and SB (4 fr) technique. The first attempt was performed at the level of the first tracheal cartilage with subsequent experimental trials of insertion progressively more caudad. Success was defined as intratracheal placement of cannula as seen on bronchoscope. Complications were assessed both by bronchoscopic and macropathological appearance. Results 32 attempts were made at tracheotomy. CM had an overall success rate of 100% compared to a 75% success rate for SB. Success rate for the first attempt was dependent on the level of the tracheotomy (Level 1 100%, level 2 62.5% and level 3 & 4 25%). While CM was associated with lateral and/or posterior wall damage on bronchoscopy/macropathology in 6% of 19% and 25% of 50% respectively, the damage observed was greater and more frequent with SB (19%/44% and 31%/50%, respectively). Conclusions At level 1, the first attempt success rate was 100% for both devices. Overall CM showed a better success rate than SB; however, both techniques were associated with significant complication rates, which were more pronounced following the scalpel bougie technique. |
| Databáze: | OpenAIRE |
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