Mitigating “cannot ventilate, cannot oxygenate” (CVCO) scenario following accidental transection of the endotracheal tube during maxillofacial surgery

We report a case of accidental transection of a nasal RAE endotracheal tube (ETT) and subsequent management in a 24-year-old male undergoing maxillary and mandibular osteotomy. Forty-five minutes into the procedure, transection of ETT by the surgical drill resulted in a progressive decrease in tidal volumes and a decline in oxygen saturation. After failing to exchange the ETT over a tube exchanger, a soft suction catheter was threaded through the RAE tube to provide oxygenation and borrow time to re-intubate through the opposite nostril. Suction catheter is a viable tool to maintain oxygenation and mitigate “Cannot Ventilate, Cannot Oxygenate” scenario during accidental transection of ETT.