A case series of the Royal Perth Hospital cannula-first approach in the 'can't intubate, can't oxygenate' scenario.

At the Royal Perth Hospital, we have been developing and teaching a can't intubate, can't oxygenate (CICO) rescue algorithm for over 19 years, based on live animal simulation. The algorithm involves a 'cannula-first' approach, with jet oxygenation and progression to scalpel techniques if required in a stepwise fashion. There is little reported experience of this approach to the CICO scenario in humans. We present eight cases in which a cannula-first Royal Perth Hospital approach was successfully implemented during an airway crisis. We recommend that institutions teach and practice this approach; we believe it is effective, safe and minimally invasive when undertaken by clinicians who have been trained in it and have immediate access to the requisite equipment. The equipment is low cost, comprising a 14G Insyte cannula, saline, 5 ml syringe and a Rapid-O2. Training can be provided using low-fidelity manikins or part-task trainers.

Early experience in use of videolaryngoscopy by a neonatal pre-hospital and retrieval service.

OBJECTIVE: To describe initial experience with use of the Glidescope Go videolaryngoscope by an Australian neonatal pre-hospital and retrieval service. METHODS: We conducted a 31-month retrospective review of an airway registry for neonates intubated by MedSTAR Kids clinicians. RESULTS: Twenty-two patients were intubated using the Glidescope Go, compared with 50 using direct laryngoscopy. First-pass success was 17/22 (77.3%) with the Glidescope Go and 38/50 (76%) with direct laryngoscopy. Complications occurred in 7/22 (32%) and 8/50 (16%), respectively. CONCLUSIONS: On initial review of this practice change, videolaryngoscopy allows neonatal tracheal intubation with a comparable success rate to direct laryngoscopy in a pre-hospital and retrieval setting.

Comparison of first-pass intubation success rates between two different videolaryngoscopes in an Australian prehospital and retrieval medicine service.

OBJECTIVE: To determine the effectiveness of the GlideScope Go videolaryngoscope (VL) in tracheal intubation in an Australian physician-staffed critical care prehospital and retrieval medicine service. METHODS: Our service has used VLs for several years, including the McGrath Mac, and from February 2019 the GlideScope Go. Clinicians may alternatively use direct laryngoscopy with a Macintosh laryngoscope. We conducted a non-inferiority trial comparing first-pass intubation success using the GlideScope Go VL with that using the McGrath Mac VL. We collected data on video intubation of all adult patients between February 2017 and December 2019, by our service. Comparison was also made with patients intubated using direct laryngoscopy with a Macintosh direct laryngoscope. RESULTS: One hundred and seventy-two patients were intubated with the aid of a VL. First-pass success rates (95% confidence interval [CI]) were 0.98 (0.92-0.99) and 0.92 (0.84-0.96), respectively, for the GlideScope Go and McGrath Mac, giving a difference (95% CI) in first-pass success rates of 0.06 (-0.01 to 0.13). First-pass success rate for the Macintosh laryngoscope was 0.88 (0.84-0.91). CONCLUSIONS: We demonstrated that first-pass success rates with the GlideScope Go are at least as good as our service had achieved with both the McGrath Mac and with direct laryngoscopy.