Transtracheal ventilation – Needle or Knife?
“I Can’t intubate and can’t ventilate. Now what? Surgical cric? That neck seems rather small… what do I do?”
- Transtracheal ventilation is imperative for the EM physician to know how to perform.
- It is faster, easier, less cumbersome and less complications than surgical cricothyrotomy (even
in adults, but especially in children).
- Infants and children have smaller cricothyroid membranes and the entire larynx is more rostral
with a more prominent hyoid bone, all of which make the surgical cricothyrotomy more difficult
in children than adults.
- “Many” state that a surgical cric. is contraindicated in patients less than 5 years of age
(although, size more than age is the limiting factor).
You will need:
- In-line valve to control gas flow
- If you are lucky: a commercial device with built in pressure gauge and regulator (like the one we have in the Peds Airway Cart).
- If you are MacGyver: oxygen tubing with a Y-connector or 3-way stopcock placed in-line as a regulator.
- 16-18 gauge catheter
Recommended Inspiration:Expiration ratios
- Standard – 1:4 to 1:5
- Supraglottic airway obstruction – 1:9 (need more time to let gas escape, otherwise may build up too much pressure in the lungs)
Refereneces:Bould, M.D. and P. Bearfield, Techniques for emergency ventilation through a needle cricothyroidotomy. Anaesthesia, 2008. 63(5): p. 535-9.Mittal, M.K. and J.M. Baren, Percutaneous Transtracheal Ventilation, in Textbook of Pediatric Emergency Procedures, 2nd Edition, C. King and F.M. Henretig, Editors. 2008, Lippincott Williams & Wilkins. p. 237-246.Slutsky, A.S., et al., Tracheal insufflation of O2 (TRIO) at low flow rates sustains life for several hours. Anesthesiology, 1985. 63(3): p. 278-86.
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nice to know
[…] to contemplate how to manage this scenario before it arises. We have previously discussed Transtracheal Ventilation and have several videos to view, but let us review this important topic briefly once more. […]
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