Correspondence (letter to the editor): Use of Developed Products Preferable

The CME article on the treatment of pediatric emergencies (1) is intended to allow the reader to provide a treatment that is “goal-oriented and appropriate to the special needs of sick children”. The authors correctly regard emergency cricothyrotomy as a last resort. However, their recommendation for respiratory management in this case appears to contradict the objective of providing postgraduate training: “A puncture coniotomy is performed with a 14 Gauge venous canula, which can then be connected to the ventilation bag either through a 3.5 mm endotracheal tube connector or through a 10 mL syringe and a blocked tube.” A chapter in a book on transtracheal ventilation is cited (2) and the connection of an anesthesia bag is described. This is all in accordance with the widespread misapprehension that the respiratory channel created by cricothyrotomy allows adequate ventilation (3).

The “do-it-yourself” instructions for emergency cricothyrotomy sets seem rather questionable in view of the availability of properly designed medical products. The lumen of an intravenous cannula should be as large as possible; the wall thickness should be low and the material flexibility high. Current products can fulfill these requirements, but this makes them unsuitable for creating temporary access to the respiratory tract after the metal cannula has been removed (unfortunately, this step was not mentioned). They readily kink at the skin, as most users well know from their practical experience with venous access.

The self-assembled set uses a 14G intravenous with a defined internal diameter of 1.7 mm, an external diameter of 2.1 to 2.2 mm (depending on the manufacturer), and a wall thickness of 0.4 to 0.5 mm. In comparison, a commercially available set for puncture cricothyrotomy, with an internal diameter of 2.0 mm, has a larger lumen, much higher flow (Hagen-Poiseuille Law) and greater wall stability.

Therefore, specially developed products should be favored for this rare indication, in order to reduce additional risks—such as having to look for individual components or disconnection—in these extreme situations, in which there are major problems in oxygenating the child.