Cricothyroidotomy

Academic …, 2012

Objectives: Emergency cricothyroidotomy is potentially lifesaving in patients with airway compromise who cannot be intubated or ventilated by conventional means. The literature remains divided on the best insertion technique, namely, the open ⁄ surgical and percutaneous methods. The two are not mutually exclusive, and the study hypothesis was that an ''incision-first'' modification (IF) may improve the traditional needle-first (NF) percutaneous approach. This study assessed the IF technique compared to the NF method.

British Journal of Anaesthesia, 2010

† Anaesthetists may be reluctant to perform emergency cricothyroidotomy in a 'cannot intubate cannot ventilate' scenario. † Percutaneous cricothyroidotomy uses skills familiar to anaesthetists and this study compared three cuffed cricothyroidotomy devices. † The cuffed Melker w had the highest success rate and was ranked highest by anaesthetists. † The Quicktrach 2 w device had the fastest insertion times and caused least posterior laryngeal wall trauma. † The PCK w device had the lowest success rate and caused most posterior wall trauma. Background. Emergency cricothyroidotomy is a potentially life-saving procedure in the 'cannot intubate cannot ventilate (CICV)' scenario. Although surgical cricothyroidotomy remains the technique recommended in many 'CICV' algorithms, the insertion of a tracheostomy as a cannula over a trocar, or using the Seldinger method, may have advantages as they are more familiar to the anaesthetist. We compared the utility of three cuffed cricothyroidotomy devices: cuffed Melker w , Quicktrach 2 w , and PCK w devices, with surgical cricothyroidotomy. Methods. After ethical committee approval and written informed consent, 20 anaesthetists performed cricothyroidotomy with all four devices in random order, in a pig larynx and trachea model covered in cured pelt. The primary endpoints were the rate of successful placement of the cricothyroidotomy device into the trachea and the duration of the insertion attempt. Results. The Melker w and Quicktrach 2 w devices possessed advantages over the surgical approach, in contrast to the PCK w device, which performed less well. All 20 participants inserted the Melker w , with 19 being successful using the surgical approach and the Quicktrach 2 w , whereas only 12 successfully inserted the PCK w device (PCK w vs surgical, P¼0.02). The Quicktrach 2 w had the fastest insertion times and caused least trauma to the posterior tracheal wall. The Melker w was rated highest by the participants and was the only device rated higher than the surgical technique. Conclusions. The Melker w and Quicktrach 2 w devices appear to hold particular promise as alternatives to surgical cricothyroidotomy. Further studies, in more clinically relevant models, are required to confirm these initial positive findings.

Korean Journal of Anesthesiology

Background: The ideal emergency cricothyroidotomy technique remains a topic of ongoing debate. This study aimed to compare the cannula-to-Melker technique with the scalpel-bougie technique and determine whether yearly training in cricothyroidotomy techniques is sufficient for skill retention. Methods: We conducted an observational crossover bench study to compare the cannula-to-Melker with the scalpel-bougie technique in a porcine tracheal model. Twenty-eight anesthetists participated. The primary outcome was time taken for device insertion. Secondary outcomes were first-pass success rate, incidence of tracheal trauma, and technique preference. We also compared the data on outcome measures with the data obtained in a similar workshop a year ago. Results: The scalpel-bougie technique was significantly faster than the cannula-to-Melker technique for cricothyroidotomy (median time of 45.2 s vs. 101.3 s; P = 0.001). Both techniques had 100% success rate within two attempts; there were no significant differences in the first-pass success rates and incidence of tracheal wall trauma (P > 0.999 and P = 0.727, respectively) between them. The relative risks of inflicting tracheal wall trauma after a failed cricothyroidotomy attempt were 6.9 (95% CI 1.5-31.1), 2.3 (95% CI 0.3-20.7) and 3.0 (95% CI 0.3-25.9) for the scalpel-bougie, cannula-cricothyroidotomy, and Melker-Seldinger airway, respectively. The insertion time and incidence of tracheal wall trauma were lower when the present data were compared with data from a similar workshop conducted the previous year. Conclusions: This study supports the use of a scalpel-bougie technique for cricothyroidotomy by anesthetists and advocates a yearly training program for skill retention.

Journal of cardiovascular and thoracic research, 2012

Unsuccessful tracheal intubation is considered the most common cause of anesthesia death or brain damage. This study delineates our experience recommending modifications in the cricothyroidotomy technique. Thirty emergency medicine residents of participated in a study performed on the human simulator moulage in Skill Laboratory of Tabriz University of Medical Science. The cricothyroid membrane was punctured using a 16-gauge cannula. Later, J guide wire was advanced into trachea and standard 16-gauge intravenous cannula with a removable needle stylet withdrawn after the puncture being dilated by a dilator. Consequently, a cuffed tracheal tube (ID= 6) was introduced from the foramen. From 30 residents, 18 residents performed cricothyroidotomy within 1 minute, 7 residents in 2 minutes and 5 residents failed to fulfill the procedure. Several studies using cadavers and human simulators have demonstrated the pre-hospital feasibility of this technique. However, descriptions of clinical pre...

2019

op right Ackno ledgement tatement "The author(s) hereby certify that the u e of any original work b another author or copyrighted material used in the DNP project entitled: 'E aluation of Cricothyroidotomy Training During a 'Can't lntubate Can't Ventilate cenario' is either appropriat ly cit d, ithin the manuscript or u ed with formal written permission of copyright release by the owner of the original work." Uniformed ervices University March 1 2019 RN Captain, Daniel K. Inouye Graduate ch ol of UT ing Uniformed ervices niversity arch 1, 2019

Anaesthesia and intensive care

The Journal of Emergency Medicine, 2011

e Abstract-Background: According to different algorithms of airway management, emergency cricothyrotomy is the final step in managing the otherwise inaccessible airway. As an alternative to an open surgical procedure, minimally invasive approaches exist. Various sets for different methods are commercially available. QuickTrach™ (VBM Medizintechnik GmbH, Sulz am Neckar, Germany) contains a plastic cannula over a metal needle for direct placement in the trachea, whereas a guide-wire is used for the actual placement of the cannula in the Melker Set™ (Cook Group Incorporated, Bloomington, IN). Objective: We hypothesize that the direct puncture involving less discrete steps is faster to perform. However, it will lead to more complications due to the higher force needed to place the relatively thick needle. Method: After approval of the local ethics committee, the study was performed on cadavers of 16 adult sheep. A wire-guided cricothyrotomy was compared with a catheter-over-needle technique. Successful placement and performance time were compared. Complication rate and maximal achieved airway pressure were evaluated. Data is given as mean and interquartile range, and Mann-Whitney U-test (p < 0.05) for significant differences. Results: With the wire-guided technique, successful placement was possible in all attempts. The catheter-over-needle method was successful in 63% and had a higher complication rate (75% vs. 13%). The cannula-over-needle method allowed a faster cricothyrotomy 32 [2-34] vs. 53 [52-56] s). Both methods allowed the delivery of similar maximal airway pressures (50 [44 -51] vs. 48 [43-53] mbar). Conclusion: The wireguided method proved to be the more reliable technique, leading to fewer complications. However, the direct puncture was faster to perform. Placed accurately, both devices allowed sufficient ventilation.

Intensive Care Medicine, 1985

Cricothyroidotomies instead of tracheostomies were performed in 61 adult patients over a period of two years. The indications were as for tracheostomy. The majority of the patients had severe trauma, respiratory problems and sepsis. The procedure was to be found easy and fast. There were no severe complications during or directly after the operation. Of the 23 surviving patients 7 were lost for follow up, 16 patients were reexamined 6 months after decanulation. No serious complications had developed, although 2 patients had minor granulation tissue formation at the stoma site and 1 had a minimal anterior narrowing of the subglottic region without granulation tissue. None of these patients needed treatment.

Anesthesia & Analgesia, 2008

BACKGROUND: We compared two emergency cricothyroidotomy kits designed to avoid lesions during insertion, one based on the Seldinger technique (ST), the other based on the concept of a mechanical detection of the posterior wall of the larynx, with regard to insertion time, success rate, and complication rate. METHODS: Cricothyroidotomy was performed under fiberoptic control in 40 human cadavers embalmed according to Thiel's technique. The set chosen for use was randomized: new technique (NT) or ST. Duration of the procedure, success rates, and incidence of laryngeal injuries were compared. Traumatic lesions observed with the fiberoptic bronchoscope were anatomically confirmed after dissection. RESULTS: The two groups had comparable epidemiological and anatomical records. Cricothyroidotomy was performed faster with the NT than with the ST (median 54 vs 71 s, P ϭ 0.01). Failure rates were comparable between groups (4 vs 1, P ϭ 0.34), and there were fewer major complications in the posterior tracheal wall with the ST (0 vs 8, P ϭ 0.003). In the ST group, only minor punctiform lesions of the posterior trachea wall were observed in four cases. CONCLUSIONS: In this model, despite a shorter insertion time, the NT produced more lesions and more failures than the ST.

The American Journal of Emergency Medicine, 2004

We propose a simple and flexible connection setup for needle cricothyroidotomy. Needle cricothyroidotomy is a life-saving procedure. It is technically easy to perform, but it cannot provide adequate ventilation for a long period of time. The standard recommended ventilation equipment for needle cricothyroidotomy consists of a jet insuflator connected to a source of oxygen with 50 psi pressure. Such a setup is not always available in emergency situations. Alternative setups using ventilation with a bag-valve had been proposed. All of them are either too bulky or rigid, which increase the chance of cricothyroidotomy catheter dislodgment. Connection proposed by us is flexible, readily available, and easy to set up.