Time to oxygenation for cannula‐ and scalpel‐based techniques for emergency front‐of‐neck access: a wet lab simulation using an ovine model

Summary Emergency front‐of‐neck access to achieve a percutaneous airway can be a life‐saving intervention, but there is debate about the preferred technique. This prospective, observational study was designed to compare the two most common emergency surgical airway techniques in a wet lab simulation using an ovine model. Forty‐three doctors participated. After providing standardised reading, a lecture and dry lab benchtop training, participants progressed to a high‐fidelity wet lab simulation. Participants entered an operating theatre where a ‘cannot intubate, cannot oxygenate’ situation had been declared and were directed to perform emergency front‐of‐neck access: first with a cannula technique (14‐gauge cannula insertion with ventilation using a Rapid‐O2® cricothyroidotomy insufflation device); and subsequently, a scalpel‐bougie technique (surgical incision, bougie insertion into trachea and then tracheal tube passed over bougie, with ventilation using a self‐inflating bag). The primary end‐point was time from declaration of ‘cannot intubate, cannot oxygenate’ to delivery of oxygen via a correctly placed percutaneous device. If a cannula or tracheal tube was not placed within 240 s, the attempt was marked as a failure. There was one failure for the cannula approach and 15 for the scalpel‐bougie technique (OR 0.07 (95%CI 0.00–0.43); p