{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T18:30:30Z","timestamp":1740162630275,"version":"3.37.3"},"reference-count":33,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2019,10,10]]},"published-print":{"date-parts":[[2019,11]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>During a \u2018cannot intubate, cannot oxygenate\u2019 situation, asphyxia can lead to cardiac arrest. In this stressful situation, two complex algorithms facilitate decision-making to save a patient\u2019s life: difficult airway management and cardiopulmonary resuscitation. However, the extent to which competition between the two algorithms causes conflicts in the execution of pivotal treatment remains unknown. Due to the rare incidence of this situation and the very low feasibility of such an evaluation in clinical reality, we decided to perform a randomised crossover simulation research study. We propose that even experienced healthcare providers delay cricothyrotomy, a lifesaving approach, due to concurrent cardiopulmonary resuscitation in a \u2018cannot intubate, cannot oxygenate\u2019 situation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Due to the rare incidence and dynamics of such a situation, we conducted a randomised crossover simulation research study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>We collected data in our institutional simulation centre between November 2016 and November 2017.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>We included 40 experienced staff anaesthesiologists at our tertiary university hospital centre.<\/jats:p><\/jats:sec><jats:sec><jats:title>Intervention<\/jats:title><jats:p>The participants treated two simulated patients, both requiring cricothyrotomy: one patient required cardiopulmonary resuscitation due to asphyxia, and one patient did not require cardiopulmonary resuscitation. Cardiopulmonary resuscitation was the intervention. Participants were evaluated by video records.<\/jats:p><\/jats:sec><jats:sec><jats:title>Primary outcome measures<\/jats:title><jats:p>The difference in \u2018time to ventilation through cricothyrotomy\u2019 between the two situations was the primary outcome measure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The results of 40 participants were analysed. No carry-over effects were detected in the crossover design. During cardiopulmonary resuscitation, the median time to ventilation was 22 s (IQR 3\u201340.5) longer than that without cardiopulmonary resuscitation (p=0.028), including the decision-making time.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Cricothyrotomy, which is the most crucial treatment for cardiac arrest in a \u2018cannot intubate, cannot oxygenate\u2019 situation, was delayed by concurrent cardiopulmonary resuscitation. If cardiopulmonary resuscitation delays cricothyrotomy, it should be interrupted to first focus on cricothyrotomy.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2019-030430","type":"journal-article","created":{"date-parts":[[2019,11,25]],"date-time":"2019-11-25T09:35:19Z","timestamp":1574674519000},"page":"e030430","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Impact of cardiopulmonary resuscitation on a cannot intubate, cannot oxygenate condition: a randomised crossover simulation research study of the interaction between two algorithms"],"prefix":"10.1136","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7510-7679","authenticated-orcid":false,"given":"Thomas","family":"Ott","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jascha","family":"Stracke","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susanna","family":"Sellin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marc","family":"Kriege","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gerrit","family":"Toenges","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carsten","family":"Lott","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sebastian","family":"Kuhn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristin","family":"Engelhard","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,11,24]]},"reference":[{"doi-asserted-by":"publisher","key":"2024052014202618000_9.11.e030430.1","DOI":"10.1016\/j.resuscitation.2015.07.017"},{"doi-asserted-by":"publisher","key":"2024052014202618000_9.11.e030430.2","DOI":"10.1093\/bja\/aev371"},{"doi-asserted-by":"publisher","key":"2024052014202618000_9.11.e030430.3","DOI":"10.1007\/s00101-015-0087-6"},{"doi-asserted-by":"publisher","key":"2024052014202618000_9.11.e030430.4","DOI":"10.1097\/ALN.0b013e31827773b2"},{"doi-asserted-by":"publisher","key":"2024052014202618000_9.11.e030430.5","DOI":"10.1097\/ACO.0b013e32834dd1eb"},{"doi-asserted-by":"publisher","key":"2024052014202618000_9.11.e030430.6","DOI":"10.1016\/j.resuscitation.2015.07.038"},{"key":"2024052014202618000_9.11.e030430.7","doi-asserted-by":"crossref","first-page":"1297","DOI":"10.1016\/j.ajem.2015.06.066","article-title":"The pathophysiologies of asphyxial vs dysrhythmic cardiac arrest: implications for resuscitation and post-event management","volume":"33","author":"Varvarousis","year":"2015","journal-title":"Am J Emerg Med"},{"key":"2024052014202618000_9.11.e030430.8","doi-asserted-by":"crossref","first-page":"1707","DOI":"10.1177\/000313481107701248","article-title":"Outcomes and long term follow-up after emergent cricothyroidotomy: is routine conversion to tracheostomy necessary?","volume":"77","author":"Graham","year":"2011","journal-title":"Am Surg"},{"doi-asserted-by":"publisher","key":"2024052014202618000_9.11.e030430.9","DOI":"10.1002\/bjs.10526"},{"doi-asserted-by":"publisher","key":"2024052014202618000_9.11.e030430.10","DOI":"10.1093\/bja\/aer058"},{"doi-asserted-by":"publisher","key":"2024052014202618000_9.11.e030430.11","DOI":"10.1093\/bja\/aer059"},{"doi-asserted-by":"crossref","unstructured":"Cheng A , Kessler D , Mackinnon R , et al . 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