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A simulated 'can't intubate, can't oxygenate' manikin crossover study investigating a modified front-of-neck access airway device.
Anaesth Intensive Care
December 2024
Department of Anaesthesia, Royal Hobart Hospital, Hobart, Australia.
A 'can't intubate, can't oxygenate' (CICO) situation is an uncommon and time-critical emergency. Many institutions have adopted a 'scalpel-bougie-endotracheal tube (ETT)' technique based on evidence produced by the 4th National Audit Project of the Royal College of Anaesthetists and 2015 Difficult Airway Society guidelines. We made a modification to the traditional 'scalpel-bougie-ETT' technique, using a shortened bougie and replacing the ETT with a cuffed Melker airway in a preassembled device (called 'Secure Airway for Front-of-neck Emergencies' (SAFE airway device)), which we felt might reduce cognitive load on a single operator in an emergency CICO situation.
View Article and Find Full Text PDFA high-fidelity non-animal model for simulation of infant emergency front-of-neck access.
Br J Anaesth
December 2024
Ara Manawa (Design & Innovation Studio), Te Whatu Ora (Health New Zealand), Auckland, New Zealand.
Controversies in the Management of the Airway in Panfacial Fractures: A Literature Review and Algorithm Proposal.
J Clin Med
November 2024
Department Oral and Maxillofacial Surgery, University Hospital Zürich, 8032 Zürich, Switzerland.
Panfacial fractures are complex fractures involving multiple regions of the facial skeleton and may require multiple surgeries over a relatively short period. They are often associated with polytrauma and other injuries including neurotrauma, which require either immediate (ATLS) airway management, prolonged intubation, or repeated intubations for staged surgeries. The choice of airway for the surgical management of these fractures is difficult, as an assessment of the occlusion is required, and the central nasal complex and/or skull base may be involved, making classical orotracheal or nasotracheal intubation problematic.
View Article and Find Full Text PDFCricothyroidotomy in out-of-hospital cardiac arrest: An observational study.
Resusc Plus
December 2024
Ambulance Victoria, 375 Manningham Rd, Doncaster, Melbourne, Victoria 3108, Australia.
Aim: To describe the incidence, characteristics, success rates, and outcomes of out-of-hospital cardiac arrest (OHCA) patients receiving cricothyroidotomy.
Methods: Over an 18-year period, we retrospectively analysed patient care records and cardiac arrest registry data for cricothyroidotomy cases. Multivariable logistic regression analysis was used to examine associations between study characteristics and cricothyroidotomy success.
Article Synopsis
- Emergency front of neck airway (eFONA) is a critical and high-stress procedure that can save lives, but decision-making is challenging for anaesthetists.
- Interviews with 17 UK anaesthetists revealed two key themes: the difficulty of deciding to perform eFONA and the factors that aid in making that decision.
- Factors such as cultural change, shared mental models, emotional detachment, and preparation significantly improve decision-making for anaesthetists facing eFONA situations.
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