Can't intubate, can't ventilate! A survey of knowledge and skills in a large teaching hospital

The Difficult Airway Society protocol for the 'can't intubate, can't ventilate' scenario recommends the use of kink-resistant cannula cricothyroidotomy with transtracheal jet ventilation or surgical cricothyroidotomy. This survey aimed to assess the preparedness of anaesthetists and anaesthetic assistants for emergency tracheal access.

Ninety-seven anaesthetists and 63 assistants were asked the location of the two difficult airway trolleys. The anaesthetists were asked for their choice of emergency tracheal access. Those opting for cannula cricothyroidotomy with jet ventilation were asked to demonstrate cannulation of a mock trachea. After insertion of the airway cannula, the time required to attach the jet ventilator to the anaesthetic machine oxygen outlet and insufflate a dummy lung was recorded. The time to connect to a jet ventilator was also recorded for assistants.

Five (5.2%) anaesthetists and 18 (28.6%) assistants knew the location of both airway trolleys. Sixty-one (62.9%) anaesthetists and one (1.6%) assistant did not know the location of either airway trolley. Thirty-six out of ninety-seven (37.1%) anaesthetists chose a method of tracheal access in keeping with Difficult Airway Society guidelines. Thirty-six out of ninety-seven (37.1%) anaesthetists opted for the jet ventilator, but 15 of these 36 (41.7%) could not locate the appropriate oxygen outlet on the anaesthetic machine. The median time [interquartile range (range)] to insufflate the dummy lung for the remaining 21 anaesthetists was 30 [23-32 (5.5-60)] s.

There were widespread deficits in 'can't intubate, can't ventilate' knowledge and skills. All participants received a demonstration of equipment, were shown the location and given the opportunity to rehearse a 'can't intubate, can't ventilate' drill.