title: The 'Can't intubate can't oxygenate' scenario in pediatric anesthesia: a comparison of the Melker cricothyroidotomy kit with a scalpel bougie technique.
abstract: BACKGROUND
  While the majority of pediatric intubations are uncomplicated, the 'Can't intubate, Can't Oxygenate' scenario (CICO) does occur. With limited management guidelines available, CICO is still a challenge even to experienced pediatric anesthetists.
  
  
  OBJECTIVE
  To compare the COOK Melker cricothyroidotomy kit (CM) with a scalpel bougie (SB) technique for success rate and complication rate in a tracheotomy on a cadaveric 'infant airway' animal model.
  
  
  METHODS
  Two experienced proceduralists repeatedly attempted tracheotomy in eight rabbits, alternately using CM and SB (4 fr) technique. The first attempt was performed at the level of the first tracheal cartilage with subsequent experimental trials of insertion progressively more caudad. Success was defined as intratracheal placement of cannula as seen on bronchoscope. Complications were assessed both by bronchoscopic and macropathological appearance.
  
  
  RESULTS
  32 attempts were made at tracheotomy. CM had an overall success rate of 100% compared to a 75% success rate for SB. Success rate for the first attempt was dependent on the level of the tracheotomy (Level 1 100%, level 2 62.5% and level 3 & 4 25%). While CM was associated with lateral and/or posterior wall damage on bronchoscopy/macropathology in 6% of 19% and 25% of 50% respectively, the damage observed was greater and more frequent with SB (19%/44% and 31%/50%, respectively).
  
  
  CONCLUSIONS
  At level 1, the first attempt success rate was 100% for both devices. Overall CM showed a better success rate than SB; however, both techniques were associated with significant complication rates, which were more pronounced following the scalpel bougie technique.
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Princess Margaret Hospital for Children, Perth, WA, Australia.
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Prunty
authors.forename: Alberto
authors.initials: A
authors.lastname: Aranda-Palacios
authors.forename: Andy M
authors.initials: AM
authors.lastname: Heard
authors.forename: Gordon
authors.initials: G
authors.lastname: Chapman
authors.forename: Anoop
authors.initials: A
authors.lastname: Ramgolam
authors.forename: Mary
authors.initials: M
authors.lastname: Hegarty
authors.forename: Shyan
authors.initials: S
authors.lastname: Vijayasekaran
authors.forename: Britta S
authors.initials: BS
authors.lastname: von Ungern-Sternberg
mesh_terms: D058109:Airway Management / Q000009:adverse effects / Q000295:instrumentation*; D000818:Animals; D003413:Cricoid Cartilage / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000295:instrumentation*; D023421:Models, Animal; D013517:Otorhinolaryngologic Surgical Procedures; D010102:Oxygen Inhalation Therapy / Q000009:adverse effects / Q000295:instrumentation*; D011817:Rabbits; D016683:Supine Position; D013961:Thyroid Gland / Q000601:surgery; D014140:Tracheotomy
keywords: age, neonate; age, techniques; airway; airway, airway devices; airway, difficult; child; cricothyroidotomy; equipment, infant; tracheotomy