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CRITICAL CARE AND TRAUMA

Cannot Intubate–Cannot Ventilate and Difficult Intubation Strategies: Results of a Canadian National Survey

David T. Wong, MD^*, Kevin Lai, BSc, Frances F. Chung, FRCPC^*, and Ranee Y. Ho

*Department of Anesthesiology, University of Toronto, Ontario, Canada; and McMaster University, Hamilton, Ontario, Canada

Address correspondence and reprint requests to David T. Wong, MD, Department of Anesthesiology, Toronto Western Hospital, 399 Bathurst St., Toronto, Ontario, Canada M5T 2S8. Address e-mail to david.wong{at}uhn.on.ca.

The purpose of this study was to determine the preferences of Canadian anesthesiologists in difficult intubation and cannot intubate–cannot ventilate (CICV) situations. Using a mailed survey, we asked anesthesiologists their preferences for and comfort level in using (a) alternative airway devices in a difficult intubation scenario and (b) infraglottic airway in a CICV scenario. Chi-square analysis and Student’s t-test were used for categorical and continuous variables. Nine-hundred-seventy-one of 2066 surveys were returned. In the difficult intubation scenario, the preferred alternative airway devices were lighted stylet (45%), fiberoptic bronchoscope (26%), and intubating laryngeal mask airway (20%). Only 57% of respondents had encountered a CICV situation in real life. In the CICV scenario, preferred infraglottic airways were cricothyroidotomy by IV catheter (51%), percutaneous cricothyroidotomy (28%), and tracheostomy by surgeon (14%). Anesthesiologists had little experience and were uncomfortable with open surgical infraglottic airways. Anesthesiologists with experience using infraglottic airways on mannequins were more comfortable using them in patients (P < 0.001). In conclusion, in a difficult intubation scenario, the lighted stylet has emerged as the preferred alternative airway device. In a CICV scenario, respondents preferred cricothyroidotomy by IV catheter, followed by percutaneous cricothyroidotomy and tracheostomy by surgeon. Practice on mannequins was associated with improved comfort in using infraglottic airways in patients.

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