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Can't intubate, can't oxygenate

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https://www.readbyqxmd.com/read/29656528/the-role-of-scalpel-bougie-cricothyroidotomy-in-managing-emergency-front-of-neck-airway-access-a-review-and-technical-update-for-ent-surgeons
#1
N D McNiven, J P Pracy, B A McGrath, A K Robson
In October 2016 an editorial was published jointly in Clinical Otolaryngology and the British Journal of Anaesthesia concerning the appropriate management of the difficult airway in a situation of 'Can't Intubate Can't Oxygenate' (CICO).1 It highlighted the importance of joint working between surgeons and anaesthetists and also made a case for the wider use of the scalpel-bougie cricothyroidotomy technique in securing a Front of Neck Airway (FONA), especially in an emergency. This article is protected by copyright...
April 15, 2018: Clinical Otolaryngology
https://www.readbyqxmd.com/read/29519222/should-ongoing-airway-education-be-a-mandatory-component-of-continuing-professional-development-for-college-of-intensive-care-medicine-fellows
#2
D J Brewster, C P Nickson, J J Gatward, M Staples, F Hawker
This study aimed to determine whether airway education should be introduced to the continuing professional development (CPD) program for College of Intensive Care Medicine (CICM) Fellows. A random representative sample of 11 tertiary intensive care units (ICUs) was chosen from the list of 56 units accredited for 12 or 24 months of CICM training. All specialist intensive care Fellows (n=140) currently practising at the eleven ICUs were sent the questionnaire via email. Questionnaire data collection and post-collection data analysis was used to determine basic respondent demographics, frequency of certain airway procedures in the past 12 months, confidence with advanced airway practices in ICU, participation in airway education in the past three years, knowledge of can't intubate, can't oxygenate (CICO) algorithms, preference for certain airway equipment/techniques, and support for required airway education as a component of the CICM CPD program...
March 2018: Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/29416237/front-of-neck-access-a-survey-among-anesthetists-and-surgeons
#3
Cyprian Mendonca, Imran Ahmad, Achuthapillai Sajayan, Rathinavel Shanmugam, Manu Sharma, Will Tosh, Emily Pallister, Peter K Kimani
Background and Aims: Emergency front of neck access (FONA) is the final step in a Can't Intubate-Can't Oxygenate (CICO) scenario. In view of maintaining simplicity and promoting standardized training, the 2015 Difficult Airway Society guidelines recommend surgical cricothyroidotomy using scalpel, bougie, and tube (SBT) as the preferred technique. Material and Methods: We undertook a survey over a 2-week period to evaluate the knowledge and training, preferred rescue technique, and confidence in performing the SBT technique...
October 2017: Journal of Anaesthesiology, Clinical Pharmacology
https://www.readbyqxmd.com/read/29361262/cannula-cricothyroidotomy-and-rescue-oxygenation-with-the-rapid-o2%C3%A2-oxygen-insufflation-device-in-the-management-of-a-can-t-intubate-can-t-oxygenate-scenario
#4
S Wexler, K Hall, R Y Chin, S N Prineas
We describe the successful use of cannula cricothyroidotomy and the Rapid-O2™ oxygen insufflation device (Meditech Systems Ltd, Dorset, UK) for rescue of a can't intubate/can't oxygenate (CICO) scenario in a patient with severe airway haemorrhage post-debridement of laryngeal amyloidosis. This case highlights the practical utility of a cannula technique for CICO rescue when appropriate equipment is used and when institutional measures are taken to prepare for this rare anaesthetic crisis.
January 2018: Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/29349776/effect-of-palpable-vs-impalpable-cricothyroid-membranes-in-a-simulated-emergency-front-of-neck-access-scenario
#5
C F Pairaudeau, C Mendonca, C Hillermann, I Qazi, P A Baker, R E Hodgson, S Radhakrishna
The Difficult Airway Society 2015 guidelines recommend and describe in detail a surgical cricothyroidotomy technique for the can't intubate, can't oxygenate (CICO) scenario, but this can be technically challenging for anaesthetists with no surgical training. Following a structured training session, 104 anaesthetists took part individually in a simulated can't intubate, can't oxygenate event using simulation and airway models to evaluate how well they could perform these front-of-neck access techniques. Main outcomes measures were: ability to correctly perform the technical steps; procedural time; and success rate...
May 2018: Anaesthesia
https://www.readbyqxmd.com/read/29121299/gender-power-and-leadership-the-effect-of-a-superior-s-gender-on-respiratory-therapists-ability-to-challenge-leadership-during-a-life-threatening-emergency
#6
N Pattni, M D Bould, M A Hayter, D McLuckie, L M K Noble, A Malavade, Z Friedman
Background: Effective communication within teams is crucial, especially in crisis situations. Hierarchy gradients between team members can contribute to communication failures and are influenced by many factors. The effect of gender on team performance has not been well studied. The objective of this study was to examine the effect of the physician's gender on respiratory therapists' ability to effectively challenge clearly incorrect clinical decisions during a life-threatening crisis...
October 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/28463474/the-height-of-the-cricothyroid-membrane-on-computed-tomography-scans-in-trauma-patients
#7
T Nutbeam, R Clarke, T Luff, D Enki, D Gay
Emergency cricothyrotomy is a common feature in all difficult airway algorithms. It is the final step following a 'can't intubate, can't oxygenate' scenario. It is rarely performed and has a significant failure rate. There is variation in the reported size of the cricothyroid membrane, especially across population groups. Procedural failure may result from attempting to pass a device with too large an external diameter through the cricothyroid membrane. We aimed to determine the maximum height of the cricothyroid membrane in a UK trauma population...
August 2017: Anaesthesia
https://www.readbyqxmd.com/read/28203757/human-factors-can-t-intubate-can-t-oxygenate-cico-bundle-is-more-important-than-needle-versus-scalpel-debate
#8
A W G Booth, K Vidhani
No abstract text is available yet for this article.
March 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/28203751/when-are-human-factors-not-human-factors-in-can-t-intubate-can-t-oxygenate-scenarios-when-they-are-human-factors
#9
M J Moneypenny
No abstract text is available yet for this article.
March 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/27876327/endotracheal-intubation-with-the-king-laryngeal-tube%C3%A2-in-situ-using-video-laryngoscopy-and-a-bougie-a-retrospective-case-series-and-cadaveric-crossover-study
#10
Kenneth W Dodd, Rebecca L Kornas, Matthew E Prekker, Lauren R Klein, Robert F Reardon, Brian E Driver
BACKGROUND: Removal of a functioning King laryngeal tube (LT) prior to establishing a definitive airway increases the risk of a "can't intubate, can't oxygenate" scenario. We previously described a technique utilizing video laryngoscopy (VL) and a bougie to intubate around a well-seated King LT with the balloons deflated; if necessary, the balloons can be rapidly re-inflated and ventilation resumed. OBJECTIVE: Our objective is to provide preliminary validation of this technique...
April 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27797158/the-impact-of-didactic-read-aloud-action-cards-on-the-performance-of-cannula-cricothyroidotomy-in-a-simulated-can-t-intubate-can-t-oxygenate-scenario
#11
R Harvey, L Foulds, T Housden, K A Bennett, D Falzon, A F McNarry, C Graham
Significant benefits have been demonstrated with the use of peri-operative checklists. We assessed whether a read-aloud didactic action card would improve performance of cannula cricothyroidotomy in a simulated 'can't intubate, can't oxygenate' scenario. A 17-step action card was devised by an expert panel. Participants in their first 4 years of anaesthetic training were randomly assigned into 'no-card' or 'card' groups. Scenarios were video-recorded for analysis. Fifty-three participants (27 no-card and 26 card) completed the scenario...
October 31, 2016: Anaesthesia
https://www.readbyqxmd.com/read/27646054/surgical-intervention-during-a-can-t-intubate-can-t-oxygenate-cico-event-emergency-front-of-neck-airway-fona
#12
EDITORIAL
J P Pracy, L Brennan, T M Cook, A J Hartle, R J Marks, B A McGrath, A Narula, A Patel
No abstract text is available yet for this article.
October 2016: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/27607408/impaired-ventilation-and-oxygenation-after-emergency-cricothyrotomy-recommendations-for-the-management-of-suboptimal-invasive-airway-access
#13
Matthew A Warner, Hugh M Smith, Martin D Zielinski
Invasive airway access by emergent cricothyrotomy remains an essential treatment modality in "can't intubate/can't ventilate" scenarios. Although numerous commercial devices are available, limited comparative data exist with regard to the ventilation and oxygenation parameters of these devices. We report a case of severely compromised respiratory function while using the Quicktrach II, a commercially available emergency cricothyrotomy device. Because of oxygenation and ventilatory insufficiency, our patient required emergent removal of the device and surgical tracheostomy to improve respiratory function...
November 15, 2016: A & A Case Reports
https://www.readbyqxmd.com/read/27566790/transtracheal-jet-ventilation-in-the-can-t-intubate-can-t-oxygenate-emergency-a-systematic-review
#14
REVIEW
L V Duggan, B Ballantyne Scott, J A Law, I R Morris, M F Murphy, D E Griesdale
BACKGROUND: Transtracheal jet ventilation (TTJV) is recommended in several airway guidelines as a potentially life-saving procedure during the 'Can't Intubate Can't Oxygenate' (CICO) emergency. Some studies have questioned its effectiveness. METHODS: Our goal was to determine the complication rates of TTJV in the CICO emergency compared with the emergency setting where CICO is not described (non-CICO emergency) or elective surgical setting. Several databases of published and unpublished literature were searched systematically for studies describing TTJV in human subjects...
September 2016: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/27440636/surgicric-2-a-comparative-bench-study-with-two-established-emergency-cricothyroidotomy-techniques-in-a-porcine-model
#15
L Chrisman, W King, K Wimble, S Cartwright, K B Mohammed, B Patel
BACKGROUND: 'Can't Intubate, Can't Oxygenate' is a rare but life threatening event. Anaesthetists must be trained and have appropriate equipment available for this. The ideal equipment is a topic of ongoing debate. To date cricothyroidotomy training for anaesthetists has concentrated on cannula techniques. However cases reported to the NAP4 audit illustrated that they were associated with a high failure rate. A recent editorial by Kristensen and colleagues suggested all anaesthetists must master a surgical technique...
August 2016: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/27277897/an-institutional-approach-to-the-management-of-the-can-t-intubate-can-t-oxygenate-emergency-in-children
#16
REVIEW
Stefano C Sabato, Elliot Long
The 'Can't Intubate Can't Oxygenate' emergency is rare in children. Nevertheless, airway clinicians involved in pediatric airway management must be able to rescue the airway percutaneously through the front of the neck should this situation be encountered. Little evidence exists in children to guide rescue techniques, and extrapolation of adult evidence may be problematic due to anatomical differences. This document reviews the currently available evidence, and presents a practical approach to standardizing equipment, techniques, and training for managing the 'Can't Intubate Can't Oxygenate' emergency in children...
August 2016: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/27241316/surgical-intervention-during-a-can-t-intubate-can-t-oxygenate-cico-event-emergency-front-of-neck-airway-fona
#17
J P Pracy, L Brennan, T M Cook, A J Hartle, R J Marks, B A McGrath, A Narula, A Patel
No abstract text is available yet for this article.
December 2016: Clinical Otolaryngology
https://www.readbyqxmd.com/read/27140684/the-myth-of-rescue-reversal-in-can-t-intubate-can-t-ventilate-scenarios
#18
COMPARATIVE STUDY
Mohamed Naguib, Lara Brewer, Cristen LaPierre, Aaron F Kopman, Ken B Johnson
BACKGROUND: An unanticipated difficult airway during induction of anesthesia can be a vexing problem. In the setting of can't intubate, can't ventilate (CICV), rapid recovery of spontaneous ventilation is a reasonable goal. The urgency of restoring ventilation is a function of how quickly a patient's hemoglobin oxygen saturation decreases versus how much time is required for the effects of induction drugs to dissipate, namely the duration of unresponsiveness, ventilatory depression, and neuromuscular blockade...
July 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/25496855/indications-and-results-of-emergency-surgical-airways-performed-by-a-physician-staffed-helicopter-emergency-service
#19
Joost Peters, Loes Bruijstens, Jeroen van der Ploeg, Edward Tan, Nico Hoogerwerf, Michael Edwards
BACKGROUND: Airway management is essential in critically ill or injured patients. In a "can't intubate, can't oxygenate" scenario, an emergency surgical airway (ESA), similar to a cricothyroidotomy, is the final step in airway management. This procedure is infrequently performed in the prehospital or clinical setting. The incidence of ESA may differ between physician- and non-physician-staffed emergency medical services (EMS). We examined the indications and results of ESA procedures among our physician-staffed EMS compared with non-physician-staffed services...
May 2015: Injury
https://www.readbyqxmd.com/read/25388828/transnasal-humidified-rapid-insufflation-ventilatory-exchange-thrive-a-physiological-method-of-increasing-apnoea-time-in-patients-with-difficult-airways
#20
A Patel, S A R Nouraei
Emergency and difficult tracheal intubations are hazardous undertakings where successive laryngoscopy-hypoxaemia-re-oxygenation cycles can escalate to airway loss and the 'can't intubate, can't ventilate' scenario. Between 2013 and 2014, we extended the apnoea times of 25 patients with difficult airways who were undergoing general anaesthesia for hypopharyngeal or laryngotracheal surgery. This was achieved through continuous delivery of transnasal high-flow humidified oxygen, initially to provide pre-oxygenation, and continuing as post-oxygenation during intravenous induction of anaesthesia and neuromuscular blockade until a definitive airway was secured...
March 2015: Anaesthesia
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