• L V Duggan, B Ballantyne Scott, J A Law, I R Morris, M F Murphy, and D E Griesdale.
• Department of Anesthesia, Pharmacology and Therapeutics University of British Columbia, Vancouver, BC, Canada Department of Anesthesiology and Perioperative Medicine and lauravduggan@gmail.com laura.duggan@fraserhealth.ca.
• Br J Anaesth. 2016 Sep 1; 117 Suppl 1: i28-i38.

BackgroundTranstracheal jet ventilation (TTJV) is recommended in several airway guidelines as a potentially life-saving procedure during the 'Can't Intubate Can't Oxygenate' (CICO) emergency. Some studies have questioned its effectiveness.MethodsOur goal was to determine the complication rates of TTJV in the CICO emergency compared with the emergency setting where CICO is not described (non-CICO emergency) or elective surgical setting. Several databases of published and unpublished literature were searched systematically for studies describing TTJV in human subjects. Complications were categorized as device failure, barotrauma (including subcutaneous emphysema), and miscellaneous. Device failure was defined by the inability to place and/or use the TTJV device, not patient survival.ResultsForty-four studies (428 procedures) met the inclusion criteria. Four studies included both emergency and elective procedures. Thirty studies described 132 emergency TTJV procedures; 90 were CICO emergencies. Eighteen studies described 296 elective TTJV procedures. Device failure occurred in 42% of CICO emergency vs 0% of non-CICO emergency (P<0.001) and 0.3% of elective procedures (P<0.001). Barotrauma occurred in 32% of CICO emergency vs 7% of non-CICO emergency (P<0.001) and 8% of elective procedures (P<0.001). The total number of procedures with any complication was 51% of CICO emergency vs 7% of non-CICO emergency (P<0.001) and 8% of elective procedures (P<0.001). Several reports described TTJV-related subcutaneous emphysema hampering subsequent attempts at surgical airway or tracheal intubation.ConclusionsTTJV is associated with a high risk of device failure and barotrauma in the CICO emergency. Guidelines and recommendations supporting the use of TTJV in CICO should be reconsidered.© The Author 2016. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

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