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Can't intubate, can't oxygenate

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.
September 19, 2016: British Journal of Anaesthesia
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...
September 7, 2016: A & A Case Reports
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 Several databases of published and unpublished literature were searched systematically for studies describing TTJV in human subjects...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
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
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
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.
May 30, 2016: Clinical Otolaryngology
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
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
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
Sarah L Prunty, Alberto Aranda-Palacios, Andy M Heard, Gordon Chapman, Anoop Ramgolam, Mary Hegarty, Shyan Vijayasekaran, Britta S von Ungern-Sternberg
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...
April 2015: Paediatric Anaesthesia
C E Buonopane, V Pasta, D Sottile, L Del Vecchio, A Maturo, R Merola, A Panunzi, P Urciuoli, V D'Orazi
BACKGROUND: Cricothyroidotomy is a surgical airway technique in which an airway device is inserted into the trachea through an incision made at the cricothyroid membrane. It is used for the management of the "difficult airways" and may be a lifesaving procedure in "can't intubate, can't oxygenate" situations. However, many healthcare professionals working in emergency settings have little of no experience with this procedure. Achievement of theoretical and practical knowledge of different cricothyrotomy techniques is therefore a fundamental prerequisite for those healthcare professionals...
July 2014: Il Giornale di Chirurgia
M Berry, Y Tzeng, C Marsland
BACKGROUND: Temporizing oxygenation by percutaneous transtracheal ventilation (PTV) is a recommended emergency technique in 'can't intubate, can't oxygenate' (CICO) situations. Barotrauma risk increases if expiration is obstructed. The Ventrain(®) is a new PTV device that assists expiration. Our aim was to compare key physiological outcomes after PTV with the Ventrain and the Manujet(®) in a large animal obstructed airway model. METHODS: Five anaesthetized sheep had post-apnoea PTV performed for 15 min using the Ventrain or Manujet with the proximal airway completely or critically obstructed, yielding four ventilation protocols per sheep...
December 2014: British Journal of Anaesthesia
S D Marshall, R Mehra
Guidelines outlining recommended actions are difficult to implement in the stressful, time-pressured situation of an airway emergency. Cognitive aids such as posters and algorithms improve performance during some anaesthetic emergencies; however, their effects on team behaviours have not been determined. In this study, 64 participants were randomly assigned into control (no cognitive aid) and intervention (cognitive aid provided) groups before a simulated 'can't intubate, can't oxygenate' scenario. Video analysis was undertaken of the non-technical skills and technical performance during the scenarios...
July 2014: Anaesthesia
A Duwat, S Petiot, S Malaquin, S Hinard, H Dupont
The two current cases reported present the situation of "can't intubate can't ventilate" patients with life-saving cricothyrotomy before surgical tracheotomy. These situations emphasize the necessity for clinicians to master difficult intubation and oxygenation algorithms and all available alternative techniques.
May 2014: Annales Françaises D'anesthèsie et de Rèanimation
D A Hartwell, M Grayling, R R Kennedy
Simulation has been advocated as a useful training tool, and specific manikin simulators have been developed for use in this role. Debriefing and repetition have been identified as key to achieving educational goals and, while the technical features of manikin simulators can influence simulation outcomes, their cost and infrastructure requirements reduce their suitability for smaller healthcare facilities. We describe a local solution using biomedical calibration machines and modified basic manikins already available in our institution to form a high-fidelity anaesthetic simulator at minimal cost...
May 2014: Anaesthesia and Intensive Care
K E McCrossin, H T White, S Sane
The decision to attempt a percutaneous airway in a recognised 'Can't Intubate, Can't Oxygenate' (CICO) situation may occur too late to avoid a poor outcome. Our study was designed to investigate the effect of high-fidelity simulation on the confidence and decision-making ability of anaesthesia trainees in managing CICO scenarios in subsequent simulation. Nine anaesthesia trainees from Logan Hospital participated. Pre-study questionnaires surveying confidence levels in various anaesthetic crises were completed...
March 2014: Anaesthesia and Intensive Care
L Paton, S Gupta, D Blacoe
A 53-year-old man with hypopharyngeal stenosis following curative chemoradiotherapy for a tongue base tumour presented three years later for an attempt at pharyngeal dilatation. The first attempt 6 months previously was abandoned when awake fibreoptic intubation failed due to partial airway obstruction and desaturation when the fibrescope was advanced. As mask ventilation was anticipated to be possible, a further attempt at intubation after induction of anaesthesia was judged appropriate. The backup plan was jet ventilation via a cricothyroid cannula sited pre-induction...
August 2013: Anaesthesia
A S Santoro, M G Cooper, A Cheng
A 'can't intubate, can't oxygenate' scenario in a child is fortunately extremely rare. We report a case of this life-threatening event in a four-year-old boy suffering from a rare genetic disorder, fibrodysplasia ossificans progressiva. He presented for manipulation of his dislocated jaw and was identified preoperatively as having a difficult airway. Despite extensive preparation, a catastrophic loss of airway control occurred minutes after induction of general anaesthesia, necessitating a life saving emergency tracheostomy...
November 2012: Anaesthesia and Intensive Care
Jonathan Stacey, Andrew M B Heard, Gordon Chapman, Catherine J Wallace, Mary Hegarty, Shyan Vijayasekaran, Britta S von Ungern-Sternberg
BACKGROUND: Little evidence exists to guide the management of the 'Can't Intubate, Can't Oxygenate' (CICO) scenario in pediatric anesthesia. OBJECTIVES: To compare two intravenous cannulae for ease of use, success rate and complication rate in needle tracheotomy in a postmortem animal model of the infant airway, and trial a commercially available device using the same model. METHODS: Two experienced proceduralists repeatedly attempted cannula tracheotomy in five postmortem rabbits, alternately using 18-gauge (18G) and 14-gauge (14G) BD Insyte(™) cannulae (BD, Franklin Lakes, NJ, USA)...
December 2012: Paediatric Anaesthesia
Tiscia Bernadette Stefanutto, John Feiner, Jens Krombach, Ronald Brown, James E Caldwell
BACKGROUND: In an earlier study investigating the "can't ventilate/can't intubate" clinical scenario, induction of anesthesia with thiopental 5 mg/kg and succinylcholine 1.0 mg/kg was associated with a significant risk of hemoglobin desaturation. It appeared that succinylcholine-induced apnea was responsible for the prolonged apnea. Our hypothesis was that using propofol and remifentanil for tracheal intubation might avoid prolonged apnea and subsequent desaturation attributable to muscle relaxation...
May 2012: Anesthesia and Analgesia
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