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Updated: Jun 8, 2026

Endotracheal Intubation via Tracheotomy and Subsequent Thoracotomy in Rats for Non-Survival Applications
Published on: March 15, 2024
Cannot ventilate-cannot intubate an infant: surgical tracheotomy or transtracheal cannula?
Karina Johansen1, Rolf J Holm-Knudsen, Birgitte Charabi
1Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. karinakjohansen@hotmail.com
Background:
An unanticipated difficult airway is very uncommon in infants. The recommendations for managing the cannot ventilate-cannot intubate (CVCI) situation in infants and small children are based on difficult airway algorithms for adults. These algorithms usually recommend placement of a transtracheal cannula or performing a surgical tracheotomy as a last resort. In this study, we compared the success rate and time used for inserting a transtracheal cannula vs performing a modified surgical tracheotomy in a piglet model.
Methods:
We used 10 three-week-old euthanized piglets, weighing eight kilograms each. Thirty physicians had a timed attempt of inserting a transtracheal cannula for jet ventilation. A maximum time of 120 s was allowed. Ten physicians had a timed attempt of performing a modified surgical tracheotomy after a short introduction by an ENT surgeon. The allowed time for this procedure was 240 s.
Results:
Placement of the transtracheal cannula was successful for eight of 30 physicians. Median time for successful insertion was 68 s. Surgical tracheotomy was successful for 8 of 10 physicians. Median time for successful tracheotomy was 89 s. There was a significantly higher success rate for surgical tracheotomy (P = 0.007).
Conclusions:
We found placement of a transtracheal cannula to be significantly less successful than the modified surgical tracheotomy in a piglet model. We question whether placement of a transtracheal cannula should be recommended in infants in a cannot ventilate-cannot intubate situation.
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