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

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 <0.001). Median (IQR [range]) time to oxygenation, if successful, was 65 (57-78 [28-160]) s for the cannula approach and 90 (74-115 [40-265]) s for the scalpel-bougie technique (p=0.005). In this ovine model, emergency front-of-neck access using a cannula had a lower chance of failure and (when successful) shorter time to first oxygen delivery compared with a scalpel-bougie technique.

A research nurse: enhancing participation in clinical trials.

The Fargo CCOP believes that a Research Nurse enhances their participation in clinical trials. Although it is early in our evaluation, the CCOP has maintained a stable accrual level despite the loss of a Medical Oncologist that historically led our research accrual totals. It may also be noted that enhancing treatment protocol participation increases cancer control participation as illustrated in the figure below. Cancer Control accrual is very respectable and positions the Fargo CCOP among the leaders in the North Central Cancer Treatment Group. The Cancer Control protocols are very time intensive. It would have been extremely difficult for the Medical Oncology Nursing staff to add cancer control research responsibilities to an already busy work day. Although subjective, communication between nurses, physicians, and data managers has been enhanced. Medical Oncology nurses have also begun to do more extensive telephone follow up with non-study patients. Minor violations appear to be decreasing. In summary, the Fargo CCOP plans to continue support of the Research Nurse role. Centralizing the accountabilities identified with one individual provides a mechanism for better communication, patient compliance, and higher patient accrual to cancer treatment and cancer control protocols. This approach may be helpful to other community cancer programs that wish to enhance their participation in clinical trials and the NCI's effort to increase patient accrual to high priority protocols.