Solving the Problem of Delivering Oxygen during Needle Cricothyroidotomy

BY RICAURTE A. SOLIS, DO   When faced with a "can't intubate, can't oxygenate" crisis, the decision to move to a surgical airway must be made rapidly and deliberately. A surgical cricothyroidotomy is debatably the better approach in these situations, but a needle cricothyroidotomy may sometimes be indicated. It may be easier to perform in a very small child, for example, and although it is probably less than ideal in an adult, a rapid needle cricothyroidotomy may provide an oxygenation bridge that will prevent a critically hypoxic patient from arresting until a more definitive airway is secured.   Cricothyroidotomy with an over-the-needle catheter itself may be easy to perform, but the more technically and logistically difficult part of the procedure remains how to deliver oxygen through a 14G catheter. In the absence of a proper percutaneous transtracheal catheter oxygenation setup such as an Enk oxygen flow modulator or a Roy Rapid-O2 device, many different improvised setups have been described. These all have advantages and disadvantages, but the main disadvantage is that they involve putting together parts that were not designed to play nice with each other.   This video shows a novel setup that may be effective in providing percutaneous transtracheal catheter oxygenation. The system, consisting of large-bore suction tubing and a meconium aspirator, plus-or-minus zip ties, is connected to the oxygen regulator Christmas tree. A maximum flow rate can then be se...
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