Indications and Outcomes of Montgomery Cannulas

Abstract

Objectives: 1) Analyze the use and outcomes of Montgomery cannulas to manage the compromised airway. 2) Identify appropriate patient selection criteria for use of the Montgomery cannula. Methods: A retrospective chart review was performed on patients who had a Montgomery cannula inserted from 2003-2012. Patient variables and outcomes analyzed included: BMI, medical comorbidities, indications for a Montgomery cannula, recorded reasons for cannula failure, and complications. Results: Indications for Montgomery cannula placement included glottic stenosis (n=7), obstructive sleep apnea (n=5), bilateral vocal cord paralysis (n=4), subglottic stenosis (n=4), supraglottic swelling after radiation or chemoradiation (n=4), bulbar dystonia with paradoxical vocal cord motion (n=1), vocal cord fixation secondary to arthritis and GERD (n=1), and seizure disorder associated with airway obstruction (n=1). 75% of patients (n=15/20) had successful use of a Montgomery cannula. 25% (n=5/20) required replacement with a Jackson tracheostomy due to persistent tracheostomal granulation tissue (n=2), patient sense of greater safety with the Jackson tracheotomy tube (n=1), a posterior scar band causing airway obstruction not adequately bypassed by the cannula (n=1), and inability to care for the cannula secondary to manual dexterity issues from rheumatoid arthritis (n=1). The Montgomery cannula was used as a successful decannulation tool in four patients. Conclusions: This case series is the first to analyze use of the Montgomery cannula as an airway management tool for indications other than obstructive sleep apnea. We identify features associated with successful use of the cannula and identify the additional indication for use of a Montgomery cannula as a step down management tool leading to decannulation.