Emergency airway access in children – transtracheal cannulas and tracheotomy assessed in a porcine model

Abstract

In a piglet model, we found no significant difference in success rates or time to insert a jet ventilation cannula or an intravenous catheter transtracheally, but the incidence of complications was high. In the same model, we found a 97% success rate for performing an emergency tracheotomy within 4 min with a low rate of complications.

A randomised cross-over comparison of the transverse and longitudinal techniques for ultrasound-guided identification of the cricothyroid membrane in morbidly obese subjects

“…the localisation of the midline of the trachea, the cricotracheal interspace and the tracheal interspaces. This is useful in airway rescue situations where emergency access via the trachea would be needed, instead of access via the cricothyroid membrane (for example in smaller children , patients with tumours overlying the cricothyroid membrane and cases of subglottic obstruction), and for elective tracheostomy or retrograde intubation .…”

Cricothyroidotomy - The emergency surgical airway

“…In children, the space between the cricoid and thyroid cartilages is much narrower with 1 study describing neonates documenting a width of 3 mm and a height of 2.6 mm . For this reason, children under the age of 8 years are not candidates for this procedure and should instead be treated with modified surgical tracheostomy . Second, as the RFST is based on palpation more than visualization, the performer must be able to palpate and identify the essential landmarks, the cricoid and thyroid cartilages, in order to locate the membrane.…”

“…10 For this reason, children under the age of 8 years are not candidates for this procedure and should instead be treated with modified surgical tracheostomy. 11 Second, as the RFST is based on palpation more than visualization, the performer must be able to palpate and identify the essential landmarks, the cricoid and thyroid cartilages, in order to locate the membrane. This process can be difficult even in the hands of clinicians experienced in airway management, reportedly as few as 40% of staff anesthesiologists reported successful identification.…”

An institutional approach to the management of the ‘Can't Intubate, Can't Oxygenate’ emergency in children

“…However, the softer cartilages of neonates and infants may not offer the same protection as in adults, and a tracheal approach offers no protective ‘cage’. Holm‐Knudsen demonstrated better success rates with a scalpel technique compared with cannulae using piglets as a pediatric model . However, a scalpel FONA was allowed up to 4 min to perform, and still be deemed successful.…”