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Percutaneous Transtracheal Ventilation: Resuscitation Bags Do Not Provide Adequate Ventilation

Published online by Cambridge University Press:  28 June 2012

Edmond A. Hooker ,
Daniel F. Danzl ,
Daniel O'Brien ,
Michael Presley ,
Ginger Whitaker  and
M. Keith Sharp
Edmond A. Hooker
Affiliation:
Department of Health Services Administration, Xavier University, Cincinnati, Ohio, USA Department of Emergency Medicine, University of Louisville, School of Medicine, Louisville, Kentucky, USA
Daniel F. Danzl*
Affiliation:
Department of Emergency Medicine, University of Louisville, School of Medicine, Louisville, Kentucky, USA
Daniel O'Brien
Affiliation:
Department of Emergency Medicine, University of Louisville, School of Medicine, Louisville, Kentucky, USA
Michael Presley
Affiliation:
Department of Emergency Medicine, University of Louisville, School of Medicine, Louisville, Kentucky, USA
Ginger Whitaker
Affiliation:
Department of Mechanical Engineering, University of Louisville, School of Medicine, Louisville, Kentucky, USA
M. Keith Sharp
Affiliation:
Department of Mechanical Engineering, University of Louisville, School of Medicine, Louisville, Kentucky, USA
*
Edmond A. Hooker, MD Department of Health Services Administration, Xavier University, 3800 Victory Parkway Cincinnati, OH 45207-7331, USA E-mail: hookere@xavier.edu
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Abstract

Introduction:

Percutaneous, transtracheal jet ventilation (percutaneous transtracheal jet ventilation) is an effective way to ventilate both adults and children. However, some authors suggest that a resuscitation bag can be utilized to ventilate through a cannula placed into the trachea.

Hypothesis:

Percutaneous transtracheal ventilation (percutaneous transtracheal ventilation) through a 14-gauge catheter is ineffective when attempted using a resuscitation bag.

Methods:

Eight insufflation methods were studied. A 14-gauge intravenous catheter was attached to an adult resuscitation bag, a pediatric resuscitation bag, wall-source (wall) oxygen, portable-tank oxygen with a regulator, and a jet ventilator (JV) at two flow rates. The resuscitation bags were connected to the 14-gauge catheter using a 7 mm adult endotracheal tube adaptor connected to a 3 cc syringe barrel. The wall and tank oxygen were connected to he 14-gauge catheter using a three-way stopcock. The wall oxygen was tested with the regulator set at 15 liters per minute (LPM) and with the regulator wide open. The tank was tested with the regulator set at 15 and 25 LPM. The JV was connected directly to the 14-gauge catheter using JV tubing supplied by the manufacturer. Flow was measured using an Ohmeda 5420 Volume Monitor. A total of 30 measurements were taken, each during four seconds of insufflation, and the results averaged (milliliters (ml) per second (sec)) for each device.

Results:

Flow rates obtained using both resuscitation bags, tank oxygen, and regulated wall oxygen were extremely low (adult 215 ±20 ml/sec; pediatric 195 ±19 ml/sec; tank 358 ±13 ml/sec; wall at 15 l/min 346 ±20 ml/sec). Flow rates of 1,394 ±13 ml were obtained using wall oxygen with the regulator wide open. Using the JV with the regulator set at 50 pounds per square inch (psi), a flow rate of 1,759 ±40 was obtained.These were the only two methods that produced flow rates high enough to provide an adequate tidal volume to an adult.

Conclusions:

Resuscitation bags should not be used to ventilate adult patients through a 14-gauge, transtracheal catheter. Jet ventilation is needed when percutaneous transtracheal ventilation is attempted. If jet ventilation is attempted using oxygen supply tubing, it must be connected to an unregulated oxygen source of at least 50 psi.

Keywords

artificial respirationcatheterizationcricoid cartilageemergency medical serviceshigh-frequency jet ventilationintratracheal intubationresuscitationtracheostomytracheotomy
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 21 , Issue 6 , December 2006 , pp. 431 - 435
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2006

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References

1.Spoerel, WE, Narayanan, PS, Singh, NP: Transtracheal ventilation. Br J Anaesth 1971;43(10):932–939.CrossRefGoogle ScholarPubMed
2.Jacoby, JJ, Hamelberg, W, Ziegler, CH et al: Transtracheal resuscitation. JAMA 1956;162(7):625–628.CrossRefGoogle Scholar
3.Jacobs, HB: Emergency percutaneous transtracheal catheter and ventilator. J Trauma 1972;12(1):50–55.CrossRefGoogle ScholarPubMed
4.Jacobs, HB, Smyth, NP, Witorsch, P: Transtracheal catheter ventilation: Clinical experience in 36 patients. Chest 1974;65(1):36–40.Google ScholarPubMed
5.Smith, RB, Schaer, WB, Pfaeffle, H: Percutaneous transtracheal ventilation for anaesthesia and resuscitation: A review and report of complications. Can Anaesth Soc J 1975;22(5):607–612.CrossRefGoogle ScholarPubMed
6.Patel, RG: Percutaneous transtracheal jet ventilation: A safe, quick, and temporary way to provide oxygenation and ventilation when conventional methods are unsuccessful. Chest 1999;116(6):1689–1694.CrossRefGoogle ScholarPubMed
7.Bourgain, JL, Desruennes, E, Fischler, M, Ravussin, P: Transtracheal high frequency jet ventilation for endoscopic airway surgery: A multicentre study. Br J Anaesth 2001;87(6):870–875.CrossRefGoogle ScholarPubMed
8.Smith, RB, Myers, EN, Sherman, H: Transtracheal ventilation in paediatric patients: Case reports. Br J Anaesth 1974;46(4):313–314.CrossRefGoogle ScholarPubMed
9.Ravussin, P, Bayer-Berger, M, Monnier, P et al: Percutaneous transtracheal ventilation for laser endoscopic procedures in infants and small children with laryngeal obstruction: Report of two cases. Can J Anaesth 1987;34(1):83–86.CrossRefGoogle ScholarPubMed
10.Erasmus, FR, Ungerer, MJ: Transtracheal ventilation during microsurgery of the larynx. S Afr Med J 1973;47(18):764–766.Google ScholarPubMed
11.Singh, NP: Transtracheal Jet Ventilation as a New Technique and Experiences with Ketamine and Propanidid in India. In: Miyazaki, M, Iwatsuki, K, Fujita, M, Lunn, JN, (eds). Anesthesiology: Proceedings of the Fifth World Congress of Anesthesiologists, Kyoto, September 19–23. 1972. Amsterdam: Excerpta Medica; 1973:p 160.Google Scholar
12.Weymuller, EAJ, Pavlin, EG, Paugh, D, Cummings, CW: Management of difficult airway problems with percutaneous transtracheal ventilation. Ann Otol Rhinol Laryngol 1987; 96 (1Pt1):34–37.CrossRefGoogle ScholarPubMed
13.Levinson, MM, Scuderi, PE, Gibson, RL, Comer, PB: Emergency percuta- neous transtracheal ventilation (percutaneous transtracheal ventilation). JACEP 1979;8(10):396–400.CrossRefGoogle Scholar
14.Dunlap, LB, Oregon, E: A modified, simple device for the emergency administration of percutaneous transtracheal ventilation. JACEP 1978;7(2):42–46.CrossRefGoogle ScholarPubMed
15.Aye, LS: Percutaneous transtracheal ventilation. Anesth Analg 1983;62(6):619.CrossRefGoogle ScholarPubMed
16.Scuderi, PE, McLeskey, CH, Comer, PB: Emergency percutaneous transtracheal ventilation during anesthesia using readily available equipment. Anesth Analg 1982;61(10):867–870.CrossRefGoogle ScholarPubMed
17.deLisser, EA, Muravchick, S: Emergency transtracheal ventilation. Anesthesiology 1981;55(5):606–607.CrossRefGoogle ScholarPubMed
18.Attia, RR, Battit, GE, Murphy, JD: Transtracheal ventilation. JAMA 1975;234(11):1152–1153.CrossRefGoogle ScholarPubMed
19.Reich, DL, Schwartz, N: An easily assembled device for transtracheal oxygenation. Anesthesiology 1987;66(3):437–438.CrossRefGoogle ScholarPubMed
20.Gildar, JS: A simple system for transtracheal ventilation. Anesthesiology 1983;58(1):106 (Letter).Google ScholarPubMed
21.Cote, CJ, Eavey, RD, Todres, ID, Jones, DE: Cricothyroid membrane puncture: Oxygenation and ventilation in a dog model using an intravenous catheter. Crit Care Med 1988;16(6):615–619.CrossRefGoogle Scholar
22.Neff, CC, Pfister, RC, Van Sonnenberg, E: Percutaneous transtracheal ventilation: Experimental and practical aspects. J Trauma 1983;23(2):84–90.CrossRefGoogle ScholarPubMed
23.Yealy, DM, Stewart, RD, Kaplan, RM: Myths and pitfalls in emergency translaryngeal ventilation: Correcting misimpressions. Ann Emerg Med 1988;17(7):690–692.CrossRefGoogle ScholarPubMed
24.Hauswald, M, Ong, G, Yeoh, E: Percutaneous needle cricothyroidotomy with repetitive airway obstruction. Am J Emerg Med 1995;13(6):623–625.CrossRefGoogle ScholarPubMed
25.Gens, DR: Surgical Airway Management. In: Tintinalli, JE, Kelen, GD, Stapczynski, JS, Tintinalli, JE, eds. Emergency medicine: A Comprehensive Study Guide. 6th ed.New York: McGraw-Hill, Medical Pub. Division; 2004:119.Google Scholar
26.Orebaugh, SL: Difficult airway management in the emergency department. J Emerg Med 2002;22(1):31–48.CrossRefGoogle ScholarPubMed
27.Chong, C, Wang, T, Chang, H: Percutaneous transtracheal ventilation without a jet ventilator. Am J Emerg Med 2003;21(6):507–508.CrossRefGoogle ScholarPubMed
28.Simon, JE: Georgia Emergency Medical Services for Children Pediatric Life Support. 2003:p 103.Google Scholar
29.Stinson, TW: A simple connector for transtracheal ventilation. Anesthesiology 1977;47(2):232 (Letter).CrossRefGoogle ScholarPubMed
30.Contra Costa County Prehospital Care Manual. 2005:118. Available at http://www.cchealth.org/groups/ems/pdf/care_manual_dec_2003_changes. pdf. Accessed 01 August 2005.Google Scholar
31.Yealy, DM, Plewa, MC, Reed, JJ et al: Manual translaryngeal jet ventilation and the risk of aspiration in a canine model. Ann Emerg Med 1990;19(11):1238–1241.CrossRefGoogle Scholar
32.Smith, RB, Albin, MS, Williams, RL: Percutaneous transtracheal jet ventilation. J Clin Anesth 1996;8(8):689–690.CrossRefGoogle ScholarPubMed
33.Metz, S, Parmet, JL, Levitt, JD: Failed emergency transtracheal ventilation through a 14-gauge intravenous catheter. J Clin Anesth 1996;8(1):58–62.CrossRefGoogle ScholarPubMed
34.Soto, R, Mesa, A: New intravenous catheter not suitable for trans-tracheal jet ventilation. Anesth Analg 2001;92(4):1074.CrossRefGoogle Scholar
35.Yealy, DM, Stewart, RD, Kaplan, RM: Clarifications on translaryngeal ventilation. Ann Emerg Med 1988;17(10):1130 (Letter).CrossRefGoogle ScholarPubMed
36.Marx, JA, Hockberger, RS, Walls, RM et al: Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed.Philadelphia: Mosby/Elsevier; 2006.Google Scholar