Assessment of the percutaneous dilatational tracheostomy technique in experimental manikins and canine cadavers

Description of a novel ultrasound-guided percutaneous dilatational esophagostomy tube placement in dog cadavers

BACKGROUND

Nutritional support has become an essential part of modern veterinary medicine. Among different techniques, esophagostomy tubes have been used extensively in dogs and cats. However, general anesthesia is typically required due to the critical step of passing an instrument orally to allow identification of the esophagus in the midcervical region. Therefore, clinicians commonly face a conundrum of poor general anesthesia candidacy for those who need an esophagostomy tube placed. Additionally, esophagostomy tubes are not a viable option for patients that have difficulty opening their mouth. Ideally, a technique that circumvents the step of passing an instrument orally would be developed.

KEY FINDINGS

We report the successful development of a novel technique for esophagostomy tube placement using ultrasound guidance and serial percutaneous dilatation of the stoma in canine cadavers. Ultrasound guidance allowed for identification and avoidance of several vital structures in the cervical region.

SIGNIFICANCE

This is the first report of an esophagostomy tube placement technique that circumvents the step of passing any instrument orally to identify the esophagus in the midcervical region. Future studies are warranted to determine if this technique can be performed in live dogs.

Percutaneous dilatational tracheostomy: evaluation of YouTube videos

BACKGROUND AND OBJECTIVE

In today's rapidly changing world, the technology of social media is widely used for educational purposes. Our aim in this study was to investigate the accuracy and efficacy of video presentations of percutaneous dilatational tracheostomy procedures available on the international video sharing website YouTube.

METHODS

On 1 December 2020, the terms "percutaneous dilatational tracheostomy" and "percutaneous tracheostomy" were entered into the search feature of YouTube ( www.youtube.com ). The evaluation was made in three categories; general information about percutaneous tracheostomy, performing percutaneous tracheostomy steps and demographic features of videos.

RESULTS

The median number of viewings of the videos on the date our data were collected was 1342 (IQR, 237-8052), and the most watched video had been viewed 325,170 times. Surgical site cleaning was explained in 46 (65.7%) videos and incision site detection in 55 (78.6%) videos. Needle aspiration into the trachea, insertion of the Seldinger guidewire, dilatation, and tracheal tube placement were covered in all videos (70; 100%). Confirmation of the location of the tracheal tube with end tidal capnography, the last step of the procedure, is available in 34 videos (48.6%).

CONCLUSION

The use of inexpensive or freely available teaching materials is possible but should always be checked before use with respect to the completeness and correctness of the content conveyed. The unreflected adoption of such content can lead to serious treatment errors.

Prehospital Emergency Cricothyrotomy in Dogs Part 1: Experiences With Commercial Cricothyrotomy Kits

The surgical cricothyrotomy (CTT) has been recommended for emergency front of neck airway access (eFONA) during a cannot intubate, cannot oxygenate scenario for military working dogs (MWD) and civilian law enforcement working dogs (operational K9s). In prehospital and austere environments, combat medics and emergency medical service providers are expected to administer emergency medical care to working dogs and may only have emergency airway kits designed for humans at their disposal. The objective of this article is to provide a detailed description of the application of such devices in cadaver dogs and highlight potential alterations to manufacturer guidelines required for successful tube placement. The kits evaluated included the Portex® PCK, Melker universal cricothyrotomy kit and H&H® emergency cricothyrotomy kit. A novel technique for awake cricothyrotomy in the dog is also described, which can also be considered for in-hospital use, together with the open surgical method described for the H&H® kit. To the authors' knowledge, this is the first publication documenting and providing instruction on the application of commercial cricothyrotomy kits in dogs.

Cricothyrotomy Is Faster Than Tracheostomy for Emergency Front-of-Neck Airway Access in Dogs

Objectives: In novice final year veterinary students, we sought to: (1) compare the procedure time between a novel cricothyrotomy (CTT) technique and an abbreviated tracheostomy (TT) technique in canine cadavers, (2) assess the success rate of each procedure, (3) assess the complication rate of each procedure via a damage score, (4) evaluate the technical difficulty of each procedure and (5) determine the preferred procedure of study participants for emergency front-of-neck access.

Materials and Methods: A prospective, cross-over, block randomised trial was performed, where veterinary students completed CTT and TT procedures on cadaver dogs. Eight students were recruited and performed 32 procedures on 16 dogs. A generalised estimating equation approach to modelling the procedure times was used.

Results: The procedure time was significantly faster for the CTT than the TT technique, on average (p < 0.001). The mean time taken to complete the CTT technique was 49.6 s (95% CI: 29.5–69.6) faster on average, with a mean CTT time of less than half that of the TT. When taking into account the attempt number, the procedure time for a CTT was 66.4 s (95% CI: 38.9–93.9) faster than TT for the first attempt, and for the second attempt, this was 32.7 s (95% CI: 15.2–50.2) faster, on average. The success rate for both procedures was 100% and there was no difference detected in the damage or difficulty scores (P = 0.13 and 0.08, respectively). Seven of eight participants preferred the CTT.

Clinical Significance: CTT warrants consideration as the primary option for emergency front-of-neck airway access for dogs.