Transtracheal jet ventilation in the 'can't intubate can't oxygenate' emergency: A systematic review

L. V. Duggan, B. Ballantyne Scott, J. A. Law, I. R. Morris, M. F. Murphy, D. E. Griesdale

Résultat de recherche: Review articleexamen par les pairs

82 Citations (Scopus)

Résumé

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 Several databases of published and unpublished literature were searched systematically for studies describing TTJV in human subjects.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.

Langue d'origineEnglish
Pages (de-à)i28-i38
JournalBritish Journal of Anaesthesia
Volume117
DOI
Statut de publicationPublished - sept. 1 2016
Publié à l'externeOui

Note bibliographique

Publisher Copyright:
© 2016 The Author. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved.

ASJC Scopus Subject Areas

  • Anesthesiology and Pain Medicine

Empreinte numérique

Plonger dans les sujets de recherche 'Transtracheal jet ventilation in the 'can't intubate can't oxygenate' emergency: A systematic review'. Ensemble, ils forment une empreinte numérique unique.

Citer