Percutaneous transtracheal emergency ventilation with a self-made device in an animal model

BACKGROUND: Special equipment for emergency percutaneous transtracheal ventilation is often not immediately available. We used a self-made device consisting of a three-way stopcock connected between a G-15 transtracheal airway catheter and an oxygen supply in a simulated 'cannot intubate, cannot ventilate' scenario and tested the hypothesis that the effectiveness of the device depends on the body weight of the experimental animals. METHODS: With approval of the local animal protection committee, two groups of six pigs each with a body weight of 21 +/- 2 and 36 +/- 6 kg, respectively, were tracheally intubated and mechanically ventilated after induction of anesthesia. Hemodynamic monitoring included cardiac output and arterial, central venous and pulmonary artery pressures. An emergency transtracheal airway catheter was inserted into the trachea and a situation of partial expiratory airway obstruction was created. Each animal was ventilated for 15 min via the transtracheal airway catheter with the self-made device (FiO(2) 1.0 at an oxygen flow of 15 l x min(-1); respiratory rate of 60 min(-1); I/E ratio approximately 1:1). RESULTS: Whereas satisfactory oxygenation was achieved in all animals, sufficient ventilation was obtained only in the lightweight animals. CONCLUSIONS: Adequate oxygenation could be provided by jet-like transtracheal ventilation with a simple self-made device using easily available materials. Sufficient ventilation depends on the body weight of the animals.