title: Transtracheal jet ventilation in the 'can't intubate can't oxygenate' emergency: a systematic review.
abstract: BACKGROUND
  Transtracheal jet ventilation (TTJV) is recommended in several airway guidelines as a potentially life-saving procedure during the 'Can't Intubate Can't Oxygenate' (CICO) emergency. Some studies have questioned its effectiveness.
  
  
  METHODS
  Our goal was to determine the complication rates of TTJV in the CICO emergency compared with the emergency setting where CICO is not described (non-CICO emergency) or elective surgical setting. Several databases of published and unpublished literature were searched systematically for studies describing TTJV in human subjects. Complications were categorized as device failure, barotrauma (including subcutaneous emphysema), and miscellaneous. Device failure was defined by the inability to place and/or use the TTJV device, not patient survival.
  
  
  RESULTS
  Forty-four studies (428 procedures) met the inclusion criteria. Four studies included both emergency and elective procedures. Thirty studies described 132 emergency TTJV procedures; 90 were CICO emergencies. Eighteen studies described 296 elective TTJV procedures. Device failure occurred in 42% of CICO emergency vs 0% of non-CICO emergency (P<0.001) and 0.3% of elective procedures (P<0.001). Barotrauma occurred in 32% of CICO emergency vs 7% of non-CICO emergency (P<0.001) and 8% of elective procedures (P<0.001). The total number of procedures with any complication was 51% of CICO emergency vs 7% of non-CICO emergency (P<0.001) and 8% of elective procedures (P<0.001). Several reports described TTJV-related subcutaneous emphysema hampering subsequent attempts at surgical airway or tracheal intubation.
  
  
  CONCLUSIONS
  TTJV is associated with a high risk of device failure and barotrauma in the CICO emergency. Guidelines and recommendations supporting the use of TTJV in CICO should be reconsidered.
authors: Department of Anesthesia, Pharmacology and Therapeutics University of British Columbia, Vancouver, BC, Canada Department of Anesthesiology and Perioperative Medicine and lauravduggan@gmail.com laura.duggan@fraserhealth.ca.
authors: L V
authors: LV
authors: Duggan
authors: Department of Library Sciences, Royal Columbian Hospital, 330 East Columbia Street, New Westminster, BC, Canada V3L 3W7.
authors: B
authors: B
authors: Ballantyne Scott
authors: Department of Anesthesia, Pain Management and Perioperative Medicine, QEII Health Sciences Centre and.
authors: J A
authors: JA
authors: Law
authors: Department of Anesthesia, Pain Management and Perioperative Medicine, Victoria General Hospital, Dalhousie University, Halifax, NS, Canada.
authors: I R
authors: IR
authors: Morris
authors: Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton Alberta Canada.
authors: M F
authors: MF
authors: Murphy
authors: Department of Anesthesia, Pharmacology and Therapeutics and Department of Medicine, Division of Critical Care Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.
authors: D E
authors: DE
authors: Griesdale
mesh_terms: D058109:Airway Management / Q000009:adverse effects / Q000379:methods*; D000402:Airway Obstruction / Q000628:therapy*; D001469:Barotrauma / Q000209:etiology; D004630:Emergencies; D004868:Equipment Failure; D006611:High-Frequency Jet Ventilation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods
keywords: airway management; emergencies; respiration, artificial