Rescue oxygenation success by cannula or scalpel-bougie emergency front-of-neck access in an anaesthetised porcine model

In the obese, the evidence for the choice of the optimal emergency front-of-neck access technique is very limited and conflicting. We compared cannula and scalpel-bougie emergency front-of-neck access techniques in an anaesthetised porcine model with thick pretracheal tissue. Cannula and scalpel-bou...

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Bibliographic Details
Published in:PloS one 2020-05, Vol.15 (5), p.e0232510-e0232510
Main Authors: Umek, Nejc, Hodzovic, Iljaz, Damjanovska, Marija, Cvetko, Erika, Zel, Jurij, Seliskar, Alenka, Pintaric, Tatjana Stopar
Format: Article
Language:English
Subjects:
Anesthesia
Anesthesiology
Biology and Life Sciences
Bupivacaine
Cannulae
Comparative analysis
Emergency medical services
Intravenous therapy
Laboratory animals
Medical equipment industry
Medical errors
Medical materials
Medicine
Medicine and Health Sciences
Neck
Obesity
Oxygen
Oxygen content
Oxygenation
Physical Sciences
Placement
Research and Analysis Methods
Respiratory tract
Success
Swine
Time
Trauma
Ventilators
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Summary:In the obese, the evidence for the choice of the optimal emergency front-of-neck access technique is very limited and conflicting. We compared cannula and scalpel-bougie emergency front-of-neck access techniques in an anaesthetised porcine model with thick pretracheal tissue. Cannula and scalpel-bougie cricothyroidotomy techniques were performed in 11 and 12 anaesthetised pigs, respectively. Following successful tracheal access, oxygenation was commenced and continued for 5 min using Rapid-O2 device for cannula and circle breathing system for scalpel-bougie study groups. The primary outcome was a successful rescue oxygenation determined by maintenance of arterial oxygen saturation >90% 5 min after the beginning of oxygenation. Secondary outcomes included success rate of airway device placement, time to successful airway device placement, and trauma to the neck and airway. The success rate of rescue oxygenation was 18% after cannula, and 83% after scalpel-bougie technique (P = 0.003). The success rate of airway device placement was 73% with cannula and 92% with scalpel-bougie technique (P = 0.317). Median (inter-quartile-range) times to successful airway device placement were 108 (30-256) and 90 (63-188) seconds (P = 0.762) for cannula and scalpel-bougie emergency front-of-neck access, respectively. Proportion of animals with iatrogenic trauma additional to the procedure itself was 27% for cannula and 75% for scalpel-bougie technique (P = 0.039). Thus, in the porcine model of obesity, the scalpel-bougie technique was more successful in establishing and maintaining rescue oxygenation than cannula-based technique; however, it was associated with a higher risk of severe trauma.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0232510