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BMJ Case Rep 2018 Jan 26;2018. Epub 2018 Jan 26.

Department of Anaesthesiology, VU University Medical Centre, Amsterdam, The Netherlands.

(Un)anticipated difficult airway remains a challenge in anaesthesia. Percutaneous transtracheal jet ventilation has been shown to be an adequate technique for temporary oxygenation and ventilation and has been described as an acknowledged method in emergency settings of an unanticipated difficult airway. These emergency settings can be considered as low incidence high-risk situations. Read More

Biomed Res Int 2015 16;2015:454807. Epub 2015 Jun 16.

Department of Anesthesiology, Yokohama City University Hospital, 3-9 Fukuura Kanazawa, Yokohama, Kanagawa 236-0004, Japan.

A "cannot-ventilate, cannot-intubate" situation is critical. In difficult airway management, transtracheal jet ventilation (TTJV) has been recommended as an invasive procedure, but specialized equipment is required. However, the influence of upper airway resistance (UAR) during TTJV has not been clarified. Read More

Am J Emerg Med 2015 May 7;33(5):708-12. Epub 2015 Mar 7.

Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, USA. Electronic address:

Background: Needle-based cricothyrotomy is a common procedure for emergency department patients requiring an emergent surgical airway. Percutaneous transtracheal jet ventilation is well studied to provide oxygenation. We propose to combine these procedures into a novel, single, and sequential procedure. Read More

Br J Anaesth 2014 Dec 30;113(6):1039-45. Epub 2014 Jun 30.

Centre for Translational Physiology, University of Otago, Wellington, New Zealand Department of Anaesthesia and Pain Management, Wellington Hospital, Wellington, New Zealand

Background: Temporizing oxygenation by percutaneous transtracheal ventilation (PTV) is a recommended emergency technique in 'can't intubate, can't oxygenate' (CICO) situations. Barotrauma risk increases if expiration is obstructed. The Ventrain(®) is a new PTV device that assists expiration. Read More

J Anesth 2014 Jun 9;28(3):341-6. Epub 2013 Nov 9.

Department of Anesthesia, Nagoya City West Medical Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya, 462-8508, Japan,

Purpose: Percutaneous transtracheal ventilation (PTV) can be life-saving in a cannot ventilate, cannot intubate situation. The aim of this study was to investigate the efficacy of PTV by measuring tidal volumes (VTs) and airway pressure (Paw) in high-flow oxygen ventilation and manual ventilation using a model lung.

Methods: We examined 14G, 16G, 18G, and 20G intravenous catheters and minitracheotomy catheters. Read More

Br J Anaesth 2013 Mar 20;110(3):456-62. Epub 2012 Nov 20.

Anaesthesia and Operation Centre, Chinese PLA General Hospital, Beijing, China.

Background: Percutaneous transtracheal ventilation (PTV) via a jet ventilator (PTJV) is considered a rescue technique in difficult airway management. However, whether a conventional ventilator can generate adequate ventilation via PTV is not known. Our goal was to evaluate the tidal volume (V(T)) generated by a conventional ventilator during simulated PTV compared with PTJV in a lung model. Read More

Acad Emerg Med 2011 Oct 26;18(10):1109; author reply 1109. Epub 2011 Sep 26.

Anasthesiol Intensivmed Notfallmed Schmerzther 2011 Sep 5;46(9):608-16. Epub 2011 Sep 5.

Invasive airway management techniques are still challenging even for skilled anesthesiologists, intensivists and emergency physicians. All current percutaneous tracheostomy techniques are based on Seldinger's principle. Using the recent introduced Blue Dolphin Kit is feasible and safe, but without clear advantage compared to other kits. Read More

Paediatr Anaesth 2007 Oct;17(10):972-6

Department of Trauma Surgery, University of Jena, Jena, Germany.

Background: Special equipment for emergency percutaneous transtracheal ventilation is often not immediately available. We used a self-made device consisting of a three-way stopcock connected between a G-15 transtracheal airway catheter and an oxygen supply in a simulated 'cannot intubate, cannot ventilate' scenario and tested the hypothesis that the effectiveness of the device depends on the body weight of the experimental animals.

Methods: With approval of the local animal protection committee, two groups of six pigs each with a body weight of 21 +/- 2 and 36 +/- 6 kg, respectively, were tracheally intubated and mechanically ventilated after induction of anesthesia. Read More

J Clin Anesth 2007 May;19(3):218-21

Department of Anesthesiology and Critical Care, University of Pennsylvania Health System, Philadelphia, PA 19104-4283, USA.

This case series details successful management of life-threatening airway obstruction after carotid endarterectomy. In the first case, ventilation was restored with a Laryngeal Mask Airway. In the second case, laryngeal mask airway rescue was unsuccessful, necessitating percutaneous transtracheal jet ventilation and subsequent endotracheal intubation with direct laryngoscopy. Read More

Prehosp Disaster Med 2006 Nov-Dec;21(6):431-5

Department of Health Services Administration, Xavier University, Cincinnati, OH 45207-7331, USA.

Introduction: Percutaneous, transtracheal jet ventilation (PTJV) is an effective way to ventilate both adults and children. However, some authors suggest that a resuscitation bag can be utilized to ventilate through a cannula placed into the trachea.

Hypothesis: Percutaneous transtracheal ventilation (PTV) through a 14-gauge catheter is ineffective when attempted using a resuscitation bag. Read More

Anasthesiol Intensivmed Notfallmed Schmerzther 2006 Sep;41(9):576-87

Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie am Klinikum der Johann-Wolfgang-Goethe-Universität Frankfurt.

Invasive airway management techniques are the bottom line of most difficult airway management algorithms when less invasive measures (e.g. endotracheal intubation, bag-valve-mask ventilation, or supraglottic airways) have failed. Read More

Am J Emerg Med 2006 Jul;24(4):455-9

Department of Anesthesiology and Reanimation, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, 34840 Istanbul, Turkey, and Department of Anesthesiology and Intensive Care Medicine, University of Jena, Germany.

The oxygen flow modulator is a device for percutaneous transtracheal emergency ventilation. Simulating a respiratory arrest situation, we studied the effects of this device in comparison with a hand-triggered emergency jet injector during pulmonary resuscitation. Nine pigs were anesthetized and mechanically ventilated. Read More

Anesteziol Reanimatol 2005 Sep-Oct(5):13-7

Three methods of artificial ventilation (AV) (volumetric, high-frequency injection, and high-frequency percutaneous transtracheal jet ventilations) were studied in 340 patients when laryngeal tumors were removed, by using a Stortz laryngoscope under multicomponent general anesthesia and local airways anesthesia. Examining the parameters of respiration and circulation in the use of three AV methods has indicated the advantages of the high-frequency percutaneous ventilation that ensures the prevention of aspiration complications and steady-state values of gas exchange and blood circulation, including in those with laryngeal stenosis and at a high risk for hemorrhage. Read More

Anaesthesia 2005 Dec;60(12):1245-6

Arch Otolaryngol Head Neck Surg 2005 Oct;131(10):886-90

University of Connecticut School of Medicine, Farmington 06030, USA.

Objective: To assess the safety and efficacy of percutaneous transtracheal jet ventilation (PTJV) in the management of the difficult airway.

Design: Retrospective case series.

Setting: Academic, tertiary care medical center. Read More

Anaesthesia 2005 Aug;60(8):801-5

Department of Anaesthesiology, St Gallen Cantonal Hospital, Rorschacherstrasse 95, CH-9007 St Gallen, Switzerland.

Primary tracheostomy under local anaesthesia is indicated in the management of an anticipated difficult airway in patients in whom less invasive procedures are expected to fail or have already failed. However, primary tracheostomy is a relatively complex procedure and places not inconsiderable stress on the patient. In a prospective study in our hospital over a period of 22 months, we were able to avoid primary tracheostomy in 11 patients with very difficult airways. Read More

Br J Anaesth 2005 May 11;94(5):683-6. Epub 2005 Feb 11.

Magill Department of Anaesthesia, Queen Mary's Hospital, Sidcup DA14 6LT, UK.

We report two cases of severe upper airway obstruction caused by supraglottic oedema secondary to adult epiglottitis and Ludwig's angina. In the former case, attempts to intubate with a direct laryngoscope failed but were successful once percutaneous transtracheal jet ventilation (PTJV) had been instituted. In the case with Ludwig's angina, PTJV was employed as a pre-emptive measure and the subsequent tracheal intubation with a direct laryngoscope was performed with unexpected ease. Read More

Anesth Analg 2004 Jun;98(6):1807-8

Department of Anesthesiology, St. Gallen Cantonal Hospital, Rorschacherstrasse 95, 9007 St. Gallen, Switzerland.

Unlabelled: Subcutaneous emphysema and pneumothorax is a rare and severe complication of percutaneous transtracheal jet ventilation, usually caused by obstruction of the upper airway or displacement of the tracheal catheter. Nevertheless, it is our preferred technique for endoscopic laryngeal laser surgery. We report a patient with acute subcutaneous emphysema and pneumothorax during laser surgery, caused by unobserved laser damage and discuss the associated risk factors. Read More

Anesthesiology 2004 May;100(5):1146-50

Service d' Anesthésie Réanimation, Hôpital Henri-Mondor, 51 Avenue du Maréchal de Lattre-de-Tassigny, 94100 Créteil Cedex, France.

Background: Management strategies conceived to improve patient safety in anesthesia have rarely been assessed prospectively. The authors undertook a prospective evaluation of a predefined algorithm for unanticipated difficult airway management.

Methods: After a 2-month period of training in airway management, 41 anesthesiologists were asked to follow a predefined algorithm for management in the case of an unanticipated difficult airway. Read More

Am J Emerg Med 2003 Oct;21(6):507-8

Resuscitation 2003 Mar;56(3):329-33

Department of Anesthesiology and Intensive Care Medicine, University Hospital, 07740 Jena, Germany.

The application of percutaneous transtracheal jet ventilation for emergency ventilation depends on special equipment which is often not available outside the operating room. The oxygen flow modulator is a new specially designed device for emergency ventilation using a low pressure oxygen supply. We studied the effects of the new device in comparison with a hand triggered emergency jet injector on oxygenation and ventilation in six pigs (21+/-1 kg). Read More

Anesthesiology 2002 Jun;96(6):1519-20

Department of Anaesthesia, Critical Care, and Pain, Tata Memorial Hospital, Parel, Mumbai, India.

JEMS 2001 Mar;26(3):58-62, 64-5, 78-9 passim

Chest 1999 Dec;116(6):1689-94

Division of Pulmonary and Critical Care Medicine, G. V. (Sonny) Montgomery V. A. Medical Center, Jackson, MS 39110, USA.

Introduction: Percutaneous transtracheal jet ventilation (PTJV) with a large-bore angiocath that is inserted through the cricothyroid membrane can provide immediate oxygenation from a high-pressure (50 lb per square inch) oxygen wall outlet, as well as ventilation by means of manual triggering. The objective of this retrospective study is to highlight the potential benefit of PTJV as a temporary lifesaving procedure during difficult situations when oral endotracheal intubation is unsuccessful and bag-valve-mask ventilation is ineffective for oxygenation during acute respiratory failure.

Methods: The medical records of 29 consecutive patients who required emergent PTJV within the past 4 years were reviewed. Read More

J Clin Anesth 1996 Dec;8(8):689-90

Anesthesiology 1995 Jan;82(1):288-91

Department of Anesthesiology, University of California, San Diego Medical School.

Background: Transtracheal jet ventilation (TTJV) through a percutaneously inserted intravenous/TTJV catheter, using a high-pressure oxygen source and noncompliant tubing is a simple and quick method of effective ventilation, especially in a patient in whom the lungs cannot be ventilated via mask and/or whose trachea cannot be intubated. TTJV becomes impossible if any part of the plastic portion of the TTJV catheter kinks; although the incidence of this problem is not known, kinking of the catheter is most likely to occur as the catheter turns from a predominantly posterior to a predominantly caudad direction. These experiments tested the hypothesis that a small-angle bend in the tip of the TTJV catheter would reduce the requirement to aim the entire TTJV catheter in a caudad-directed orientation. Read More

Can J Anaesth 1994 Dec;41(12):1200-7

Department of Anaesthesia, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.

Percutaneous transtracheal high frequency jet ventilation (TTJV) in adults is frequently used during anaesthesia for laryngeal microsurgery. It provides excellent surgical operating conditions and safety for the patient. The technique has not been evaluated in infants and children. Read More

Ann Acad Med Singapore 1994 Jul;23(4):589-91

Department of Anaesthesia, University California San Diego Medical Centre 92103-8812.

Respiratory catastrophes are the most common cause of anaesthesia-related brain deaths and death. If an airway is recognised to be difficult, endotracheal tube (ETT) intubation should be performed awake. Awake intubation demands proper preparation of the patient. Read More

AANA J 1993 Aug;61(4):349

Anaesthesia 1992 Oct;47(10):855-6

Department of Anaesthesia, University of Basel/Kantonsspital, Switzerland.

A 74-year-old woman developed severe cardiovascular depression during percutaneous transtracheal high frequency jet ventilation for laser surgery of the epiglottis. This was found to be caused by acute airway obstruction secondary to severe laryngospasm. We recommend profound neuromuscular blockade during percutaneous transtracheal jet ventilation, in order to prevent this complication. Read More

J Clin Anesth 1992 Jul-Aug;4(4):321-4

Department of Anesthesiology, Medical College of Virginia, Richmond 23298-0695.

Study Objective: To evaluate the hemodynamic and respiratory effects of percutaneous transtracheal high-frequency jet ventilation (HFJV) during difficult intubation using fiberoptic bronchoscopy under general anesthesia.

Design: Prospective study.

Setting: Surgical patients scheduled for general anesthesia at the Medical College of Virginia Hospital. Read More

Anesthesiology 1991 May;74(5):952

AANA J 1990 Oct;58(5):337-9

Situations wherein patients cannot be ventilated or intubated rarely occur. When they do, however, death is imminent unless rapid and accurate actions are taken to restore adequate gas exchange. Under these circumstances, percutaneous transtracheal high-pressure jet ventilation (TTJV) through an intravenous catheter is life saving. Read More

Can J Anaesth 1988 Jul;35(4):404-5

Department of Anaesthesia, Groby Road Hospital, Leicester, England.

A case is described where prophylactic high frequency jet ventilation through a percutaneous transtracheal cannula was performed. This guaranteed adequate ventilation of a patient who was known to be difficult to intubate, enabling a paralyzing dose of succinylcholine to be given and intubation to be performed safely in a well oxygenated patient scheduled for coronary artery bypass grafting. Read More

Clin Otolaryngol Allied Sci 1988 Jun;13(3):209-17

Clinique ORL, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.

Obstructive lesions of the larynx and subglottic space are always a challenging problem for the endoscopist and anaesthetist. At this level, the efficacy and innocuity of a carbon dioxide laser treatment are related to the degree of endoscopic exposure. Thanks to the transtracheal high frequency jet ventilator, it is now possible to assure a free laryngeal endoscopic operative field. Read More

Anesthesiology 1988 Feb;68(2):298-9

Anesthesiology 1987 Aug;67(2):247-9

Can J Anaesth 1987 Jan;34(1):83-6

The case reports of two children with obstructive lesions of the larynx are presented to illustrate the advantages of transtracheal ventilation for paediatric endoscopic laser surgery. The first patient was a four-month-old infant with inspiratory stridor due to a subglottic haemangioma obstructing 80 per cent of the lumen. The second patient was a five-year-old child with posterior synechiae of the larynx. Read More

Ann Otol Rhinol Laryngol 1987 Jan-Feb;96(1 Pt 1):34-7

Percutaneous transtracheal jet ventilation was used in the management of 13 cases of upper airway obstruction. Cases are subdivided according to the nature of the presenting airway problem. The first group had stable upper airway abnormalities; the second group presented as emergencies with rapidly evolving upper airway obstruction. Read More

Crit Care Med 1984 Jan;12(1):8-13

This study compared percutaneous transtracheal jet ventilation (PTJV) at a frequency (f) of 20/min, with high-frequency positive-pressure ventilation (HFPPV) at f of 60/min, and endotracheal intubation and intermittent positive-pressure ventilation (ET IPPV) at f of 10/min in apneic dogs. Fifty-four emergency medicine trainees (EMTs) attempted PTJV via a 14-gauge Angiocath attached to a hand-held jet ventilator, f of 20/min, and ET IPPV using an Ambu bag, f of 10/min. Twenty-nine other EMTs attempted cricothyrotomy using a prototype nonkinkable catheter (Arrow) and a new jet ventilator, Bronchovent, f of 60/min, equipped with a pressure sensor which stops ventilation at pressures greater than 20 cm H2O. Read More

Can Anaesth Soc J 1980 Jul;27(4):351-6

A study was undertaken on dogs to find the limit of carbon dioxide exchange with high frequency jet ventilation using a fluidic logic controlled oxygen jet ventilator. Fifteen dogs were ventilated through a transtracheal catheter at respiratory rates up to 600 per minute. The following were recorded: aortic, pulmonary artery, pulmonary arterial wedge, and central venous blood pressures; intratracheal pressure, electrocardiogram; inspiratory and expiratory time of the jet; arterial and central venous blood gases; intermittent cardiac output. Read More

Crit Care Med 1977 Nov-Dec;5(6):280-7

JACEP 1976 Oct;5(10):765-70

The technique of percutaneous transtracheal ventilation (intermittent jets of oxygen under high pressure, 50 pounds per square inch [psi]) has been used for resuscitation during anesthesia and prior to tracheostomy, and has been established as an important adjunct to life-support techniques. The technical aspects are described together with experimental evidence that intermittent jet ventilation is necessary to eliminate carbon dioxide. The complications occurring with a series of 80 patients are reported along with experimental work in ventilation of dogs with compressed air sources, including truck tires. Read More