Background

There is a paucity of evidence regarding the optimal type of tracheal tube to be advanced over a Frova catheter when performing a ‘bougie’ emergency front-of-neck airway (eFONA) technique in infants during a ‘cannot intubate, cannot oxygenate’ situation.

Methods

A prospective non-inferiority trial in a rabbit cadaver surgical tracheotomy model to assess the performance of the eFONA technique with an uncuffed 3.5 mm ID tracheal tube vs a cuffed 3.0 mm ID tracheal tube. Queried outcomes include success rate, performance time, and severe secondary airway injuries among tracheal tube types.

Results

In 60 tracheostomies performed by 30 participants, the overall success rate was 98%. Performance time was independent from tracheal tube choice (uncuffed: 61 s [95% confidence interval (CI), 52–76], cuffed: 64 s [95% CI, 55–79]; P = 0.82). No tracheal tube type was preferred in terms of usability by participants. The cuffed tracheal tube required increased force to be advanced over the Frova catheter and was associated with a risk ratio of 2.5 (95% CI, 0.53–11.9; number needed to harm, 10) for severe secondary airway injuries when compared with the uncuffed tracheal tube.

Conclusion

In performing eFONA in the rabbit cadaver model, an ID 3.5 uncuffed is non-inferior to an ID 3.0 cuffed tracheal tube regarding performance time and preference by the operator. Greater force application to advance the cuffed tube over the Frova catheter and more severe airway injuries may argue for the standardised performance of the eFONA technique with a uncuffed tracheal tube in infants.

中文翻译：

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兔训练模型中带套囊与未套囊气管插管在婴儿中建立紧急颈前气道：一项前瞻性试验

背景

在“无法插管、无法充氧”的情况下对婴儿进行“探条”紧急颈前气道 (eFONA) 技术时，关于在 Frova 导管上推进的最佳气管导管类型的证据很少。

方法

在兔尸体气管切开术模型中进行的一项前瞻性非劣效性试验，以评估 eFONA 技术在未套囊的 3.5 mm ID 气管导管与有套囊的 3.0 mm ID 气管导管中的性能。查询的结果包括气管插管类型的成功率、执行时间和严重的继发性气道损伤。

结果

在 30 名参与者进行的 60 次气管切开术中，总体成功率为 98%。执行时间与气管插管的选择无关（不戴套囊：61 秒 [95% 置信区间 (CI)，52-76]，套囊：64 秒 [95% CI，55-79]；P = 0.82）。就参与者的可用性而言，没有首选气管插管类型。与不带气囊的气管相比，带气囊的气管导管需要更大的力才能通过 Frova 导管，并且与严重继发性气道损伤的风险比相关，为 2.5（95% CI，0.53-11.9；需要伤害的人数，10）管子。

结论

在兔尸体模型中执行 eFONA 时，ID 3.5 不带袖套的气管插管在操作时间和操作者偏好方面不逊于 ID 3.0 带袖套的气管导管。在 Frova 导管上推进带套囊管的更大力度和更严重的气道损伤可能会证明 eFONA 技术在婴儿未套囊气管导管上的标准化性能。