Percutaneous transtracheal jet ventilation for cardiopulmonary resuscitation: evaluation of a new jet ventilator.
This study compared percutaneous transtracheal jet ventilation (PTJV) at a frequency (f) of 20/min, with high-frequency positive-pressure ventilation (HFPPV) at f of 60/min, and endotracheal intubation and intermittent positive-pressure ventilation (ET IPPV) at f of 10/min in apneic dogs. Fifty-four emergency medicine trainees (EMTs) attempted PTJV via a 14-gauge Angiocath attached to a hand-held jet ventilator, f of 20/min, and ET IPPV using an Ambu bag, f of 10/min. Twenty-nine other EMTs attempted cricothyrotomy using a prototype nonkinkable catheter (Arrow) and a new jet ventilator, Bronchovent, f of 60/min, equipped with a pressure sensor which stops ventilation at pressures greater than 20 cm H2O. Adequate oxygenation was achieved by all 3 groups, but only the HFPPV group avoided respiratory alkalosis. There was a higher equipment failure rate (catheter kinking and dislodgment) in the PTJV group. In the HFPPV group, the Bronchovent's pressure-limiting sensor stopped ventilation when the catheter was kinked or out of position, reducing the extent of subcutaneous emphysema and barotrauma. With further catheter improvements, HFPPV Bronchovent may offer a safe and reliable method of ventilating patients during CPR in the field.
D000472:Alkalosis, Respiratory / Q000209:etiology; D000818:Animals; D001784:Blood Gas Analysis; D004285:Dogs; D004868:Equipment Failure; D005069:Evaluation Studies as Topic; D006801:Humans; D007385:Intermittent Positive-Pressure Ventilation; D007442:Intubation, Intratracheal; D012151:Resuscitation / Q000193:education* / Q000295:instrumentation; D012122:Ventilators, Mechanical / Q000009:adverse effects*