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The OxyTain Algorithm

An Approach to Airway Management in the Cannot Intubate and Cannot Oxygenate Scenario

Schechtman, Samuel A., MD; Buist, Michael, MD; Cloyd, Benjamin H., MD; Tremper, Kevin K., PhD, MD; Healy, David W., MD

doi: 10.1213/XAA.0000000000000982

Although rare, cannot intubate and cannot oxygenate situations are challenging acute events. The development of management algorithms, standardized equipment provisions, and appropriate clinical training in the application of front-of-neck access techniques are necessary to optimize procedural success to ensure adequate oxygenation. The OxyTain algorithm is an institutionally developed protocol to manage cannot intubate and cannot oxygenate events. With proper implementation, this unique process aligning the cannula cricothyroidotomy and scalpel bougie as primary and secondary techniques, respectively, can potentially optimize procedural success. This algorithmic approach is trained routinely among our anesthesia providers, while the equipment is standardized throughout our anesthetizing locations.

From the Department of Anesthesiology, Michigan Medicine - University of Michigan Medical School, Ann Arbor, Michigan.

Accepted for publication January 8, 2019.

Funding: This work was supported solely from institutional and/or departmental sources.

Conflicts of Interest: See Disclosures at the end of the article.

Address correspondence to Samuel A. Schechtman, MD, Department of Anesthesiology, Michigan Medicine - University of Michigan Medical School, 1H247 UH, SPC 5048, 1500 E. Medical Center Dr, Ann Arbor, MI 48109. Address e-mail to

© 2019 International Anesthesia Research Society
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