In a rabbit-model of infant front-of-neck airway rescue, a cuffed 3.0 mm ETT was non-inferior to uncuffed 3.5 mm ETT for success & time-to-perform, but required greater force.

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• Jörg Thomas, Elena Alonso, Pedro D Wendel Garcia, Birgit Diem, Michael Kemper, Markus Weiss, and Christian P Both.
• Department of Anaesthesiology, University Children's Hospital Zurich, Zurich, Switzerland; Children's Research Centre, University Children's Hospital Zurich, Zurich, Switzerland. Electronic address: Joerg.thomas@kispi.uzh.ch.
• Br J Anaesth. 2022 Feb 1; 128 (2): 382-390.

BackgroundThere is a paucity of evidence regarding the optimal type of tracheal tube to be advanced over a Frova catheter when performing a 'bougie' emergency front-of-neck airway (eFONA) technique in infants during a 'cannot intubate, cannot oxygenate' situation.MethodsA prospective non-inferiority trial in a rabbit cadaver surgical tracheotomy model to assess the performance of the eFONA technique with an uncuffed 3.5 mm ID tracheal tube vs a cuffed 3.0 mm ID tracheal tube. Queried outcomes include success rate, performance time, and severe secondary airway injuries among tracheal tube types.ResultsIn 60 tracheostomies performed by 30 participants, the overall success rate was 98%. Performance time was independent from tracheal tube choice (uncuffed: 61 s [95% confidence interval (CI), 52-76], cuffed: 64 s [95% CI, 55-79]; P = 0.82). No tracheal tube type was preferred in terms of usability by participants. The cuffed tracheal tube required increased force to be advanced over the Frova catheter and was associated with a risk ratio of 2.5 (95% CI, 0.53-11.9; number needed to harm, 10) for severe secondary airway injuries when compared with the uncuffed tracheal tube.ConclusionIn performing eFONA in the rabbit cadaver model, an ID 3.5 uncuffed is non-inferior to an ID 3.0 cuffed tracheal tube regarding performance time and preference by the operator. Greater force application to advance the cuffed tube over the Frova catheter and more severe airway injuries may argue for the standardised performance of the eFONA technique with a uncuffed tracheal tube in infants.Copyright © 2021 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

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