Percutaneous transcricoid jet ventilation compared with surgical cricothyroidotomy in a sheep airway salvage model.
BACKGROUND
We developed a large animal model of the "cannot intubate/cannot ventilate" (CNI/V) scenario to compare percutaneous transcricoid manual jet ventilation (MJV) with surgical cricothyroidotomy (SC).


METHODS
Twelve sheep weighing 40-80 kg were assigned to MJV or SC groups. After sedation, intubation, and line placement, CNI/V was simulated by removing the tracheal tube and inducing paralysis with vecuronium. When SaO2 reached 80% (t=0), MJV catheter insertion or SC was initiated. Upon successful airway placement, ventilation began using 100% oxygen at 20 breaths/min. MJV was administered at 50 psi. HR, BP, SaO2, pH, PCO2, and PO2 were recorded at t=0, 30, 60, 90, 120, 150, 180, 300, 600, and 1200 s. Data were reported as mean+/-S.E.M. over the whole observation period. Baseline values were compared using Student's t-tests. Repeated-values ANOVA was used for post-procedure group comparisons. Statistical tests were two-tailed and alpha was set at 0.05.


RESULTS
Body weights were not significantly (P=0.08) different between MJV (65+/-6 kg) and SC (52+/-3 kg) groups. Baseline respiratory and hemodynamic variables were also not significantly different. Median procedure time for MJV (20 s) and SC (24 s) was not significantly (P=0.69) different. Post-procedure values were not significantly different for SaO2 (P=0.65), pH (P=0.70), PCO2 (P=0.47), PO2 (P=0.84), MAP (P=0.09), or HR (P=0.16) over the entire 20 min resuscitation period.


CONCLUSIONS
Using a realistic model of CNI/V we found no difference in respiratory or hemodynamic variables between MJV and SC. Adequate ventilation and perfusion was maintained solely by MJV for up to 20 min.
Manoach
Seth
S
Department of Emergency Medicine, State University of New York-Downstate Medical Center and Kings County, Hospital Center, 450 Clarkson Avenue, Box 1228, Brooklyn, NY 11203, USA. seth.manoach@downstate.edu
Corinaldi
Chalene
C
Paladino
Lorenzo
L
Schulze
Robert
R
Charchaflieh
Jean
J
Lewin
Jesse
J
Glatter
Robert
R
Scharf
Bruce
B
Sinert
Richard
R
D000818:Animals; D003413:Cricoid Cartilage / Q000601:surgery*; D004638:Emergency Treatment; D005260:Female; D006611:High-Frequency Jet Ventilation / Q000379:methods; D007442:Intubation, Intratracheal; D012121:Respiration, Artificial / Q000379:methods*; D012151:Resuscitation / Q000379:methods*; D012756:Sheep; D013997:Time Factors