Background: Emergency intubations present a unique set of challenges, particularly when dealing with heavily contaminated airways. Anesthesiologist, Dr. James DuCanto, developed the DuCanto catheter to enhance airway management in these high-stakes situations. The commonly used 14 Fr Yankauer catheter, with its smaller bore, may struggle to clear heavily contaminated airways effectively. In contrast, the 28 Fr DuCanto catheter is specifically designed to handle thicker fluids which may be seen in emergency airway management, potentially making it the better choice for the ED.¹ The head-to-head performance of these devices has not been previously studied.

Paper: Finke SR, Schroeder DC, Ecker H, Böttiger BW, Herff H, Wetsch WA. Comparing suction rates of novel DuCanto catheter against Yankauer and standard suction catheter using liquids of different viscosity-a technical simulation. BMC Anesthesiol. 2022;22(1):285. Published 2022 Sep 10. PMID: 36088303

Research Question: How effective is the DuCanto catheter, compared to the Yankauer and standard suction catheters, at suctioning liquids of different viscosities?

What They Did:

• Investigators conducted a technical simulation in a laboratory setting.
• They compared the suction rates of 3 different catheters across 4 different fluid viscosities.
• Each catheter was used to suction the four different fluids for 15 seconds.
• The procedure was repeated four times for each catheter and fluid combination to ensure the reliability of the measurements.
• Data were analyzed using one-way ANOVA and the Holm-Sidak method to determine statistically significant differences between the catheters.

Comparators:

• DuCanto catheter (28 Fr, large-bore)
• Yankauer catheter (18 Fr, large-bore)
• Standard suction catheter (14 Fr)

Primary Outcome: 

Suction Rate: The amount of liquid removed by suctioning (in milligrams) during a 15-second timeframe using each of the catheters across four different fluids with standardized viscosities.

Results:

Strengths:

• Controlled Environment: The study was conducted in a controlled laboratory setting, which allowed for precise measurements of suction rates and consistent conditions across all experiments.
• Standardized Viscosity Levels: The use of standardized fluids with controlled viscosities (water, syrup-like, honey-like, pudding-like) provided a reproducible method to compare the performance of different suction catheters.
• Direct Comparison: The study directly compared three commonly used suction catheters (DuCanto, Yankauer, and standard catheter) under identical conditions, making the results relevant and easily interpretable.
• Objective Measurements: Suction performance was measured quantitatively in milligrams, providing clear, objective data on the effectiveness of each catheter.
• Multiple Trials: Each suctioning procedure was repeated four times for each catheter and viscosity level, enhancing the reliability of the results.

Limitations:

• Bench Model Simulation: The study was conducted in a laboratory setting rather than a clinical environment, which may only partially replicate the complexities and variability of real-life clinical situations.
• Lack of Corpuscular Elements: The study did not include solid or semi-solid particles (e.g., food particles, coagulated blood clots), which are often present in real-world scenarios and could affect suction performance.
• No Clinical Trials: The study did not involve human or animal subjects, so the findings are limited to technical performance and do not provide direct evidence of clinical efficacy or safety.
• Non-blinded Design: The study staff could not be blinded to the type of catheter being used, which could introduce bias, although the objective nature of the measurements likely minimized this risk.
• Device-Oriented Outcomes: While suction rate improvements were significant, the clinical relevance of these findings remains uncertain.
• Single Suction Unit Setting: The study used a single suction pressure setting (-600 mbar) for all tests, which may not represent the variability of suction pressures used in different clinical settings.
• Limited Scope of Fluids: Although the study used four standardized viscosities, it did not account for the full range of fluids that might be encountered in clinical practice, such as bile, thick mucus, or complex mixtures of bodily fluids.
• No Intubation Scenario: The study did not test the catheters in an intubation scenario, which is a common situation where effective suctioning is critical.
• Generalizability: The results, while statistically significant, are based on a specific set of conditions and may not be directly applicable to all clinical environments without further validation.

Discussion:

The Ultimate Suction Tool: The DuCanto catheter significantly outperformed both the Yankauer and standard suction catheters, showing statistically significant improvements in suction rates across all four fluid viscosity types. This data suggests that the DuCanto catheter is a far superior suction device. Beyond its impressive suction capabilities, the DuCanto catheter offers additional practical advantages. Its shape, resembling a laryngoscope, aids in blade placement during the SALAD intubation technique.¹ Additionally, the catheter’s large bore can accommodate and facilitate bougie delivery through the vocal cords, making it particularly useful in difficult or contaminated airway scenarios.³

Balancing Lab Success vs. Real-World Challenges: This study has several notable limitations. The data were collected in a controlled laboratory environment, which differs significantly from the unpredictable conditions of clinical practice where resuscitationists make rapid, life-saving decisions. The investigators did not test the catheter’s performance with liquids mixed with solids. Moreover, statistical significance may not directly translate to clinical significance. While the suction rates observed are impressive, it is unclear whether using the DuCanto catheter would lead to improved clinical outcomes. Likewise, demonstrating clinical significance could be particularly challenging, as aspiration during intubation is relatively rare. Additionally, the cost difference is small but not insignificant: a DuCanto catheter costs approximately $4 per device, compared to less than $1 for a Yankauer catheter.

Expect the Unexpected: Preparation is key for successful intubation in critically ill patients, but predicting which patients will vomit and aspirate is difficult. During emergency intubation, there is no option to consider when a patient last ate; resuscitationists must always be prepared for the unexpected and have multiple contingency plans in place. If and when vomiting occurs, having a DuCanto catheter ready for immediate use is essential. 

Author’s Conclusion: “In conclusion, suctioning substances of different viscosity from the upper airway the new DuCanto catheter was more effective than the Yankauer catheter, which was more effective compared to a standard suctioning catheter. The relative superiority of the DuCanto was highest in fluids of high viscosity.”

Our Conclusion:

The DuCanto catheter significantly outperformed both the Yankauer and standard catheters in this laboratory study. With its superior suction capabilities and added benefits in aiding laryngoscope placement and bougie delivery, the DuCanto stands out as the better choice for airway management. While clinical trials are needed to confirm its effectiveness in real-world settings, there is little downside to its use.

Clinical Bottom Line:

Resuscitationists should incorporate the DuCanto Catheter into their airway management toolkit for all emergency intubations.

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References: 

1. DuCanto J, Serrano KD, Thompson RJ. Novel Airway Training Tool that Simulates Vomiting: Suction-Assisted Laryngoscopy Assisted Decontamination (SALAD) System. West J Emerg Med. 2017;18(1):117-120. PMID: 28116021
2. Finke SR, Schroeder DC, Ecker H, Böttiger BW, Herff H, Wetsch WA. Comparing suction rates of novel DuCanto catheter against Yankauer and standard suction catheter using liquids of different viscosity-a technical simulation. BMC Anesthesiol. 2022;22(1):285. Published 2022 Sep 10. PMID: 36088303
3. Cochran-Caggiano N, Holliday J, Howard C. A Novel Intubation Technique: Bougie Introduction Via Ducanto Suction Catheter. J Emerg Med. 2024;66(2):221-224. PMID: 38296765

Post Peer Reviewed By: Anand Swaminathan, MD (Twitter/X: @EMSwami)