title: Cannot ventilate-cannot intubate an infant: surgical tracheotomy or transtracheal cannula?
abstract: BACKGROUND
  An unanticipated difficult airway is very uncommon in infants. The recommendations for managing the cannot ventilate-cannot intubate (CVCI) situation in infants and small children are based on difficult airway algorithms for adults. These algorithms usually recommend placement of a transtracheal cannula or performing a surgical tracheotomy as a last resort. In this study, we compared the success rate and time used for inserting a transtracheal cannula vs performing a modified surgical tracheotomy in a piglet model.
  
  
  METHODS
  We used 10 three-week-old euthanized piglets, weighing eight kilograms each. Thirty physicians had a timed attempt of inserting a transtracheal cannula for jet ventilation. A maximum time of 120 s was allowed. Ten physicians had a timed attempt of performing a modified surgical tracheotomy after a short introduction by an ENT surgeon. The allowed time for this procedure was 240 s.
  
  
  RESULTS
  Placement of the transtracheal cannula was successful for eight of 30 physicians. Median time for successful insertion was 68 s. Surgical tracheotomy was successful for 8 of 10 physicians. Median time for successful tracheotomy was 89 s. There was a significantly higher success rate for surgical tracheotomy (P = 0.007).
  
  
  CONCLUSIONS
  We found placement of a transtracheal cannula to be significantly less successful than the modified surgical tracheotomy in a piglet model. We question whether placement of a transtracheal cannula should be recommended in infants in a cannot ventilate-cannot intubate situation.
authors.affiliation: Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. karinakjohansen@hotmail.com
authors.forename: Karina
authors.initials: K
authors.lastname: Johansen
authors.forename: Rolf J
authors.initials: RJ
authors.lastname: Holm-Knudsen
authors.forename: Birgitte
authors.initials: B
authors.lastname: Charabi
authors.forename: Michael S
authors.initials: MS
authors.lastname: Kristensen
authors.forename: Lars Simon
authors.initials: LS
authors.lastname: Rasmussen
mesh_terms: D058109:Airway Management; D000818:Animals; D020680:Bronchoscopes; D002404:Catheterization / Q000379:methods*; D005336:Fiber Optic Technology; D006611:High-Frequency Jet Ventilation; D053208:Kaplan-Meier Estimate; D009333:Neck / Q000033:anatomy & histology; D010173:Palpation; D013552:Swine; D014132:Trachea / Q000601:surgery*; D014140:Tracheotomy / Q000379:methods*