Comparing success rates of anesthesia providers versus trauma surgeons in their use of palpation to identify the cricothyroid membrane in female subjects: a prospective observational study

Hiller, Kenneth N.; Karni, Ron J.; Cai, Chunyun; Holcomb, John B.; Hagberg, Carin A.

doi:10.1007/s12630-016-0647-5

Cited by 35 publications

(25 citation statements)

References 31 publications

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“…19 If an emergency cricothyrotomy is a backup plan, the location of the cricothyroid membrane (CTM) should be determined and marked beforehand, recognizing that existing studies indicate poor success at identification of the CTM by palpation alone. [20][21][22] Thus, if time permits, ultrasound should be used to locate the CTM. 23 The surgical safety briefing should include the planned primary and alternative intubation techniques as well as the plan for a CICO situation.…”

Section: Synthesizing a Plan From The Information Obtained From The Amentioning

confidence: 99%

“…19 Si une cricothyrotomie d'urgence est le plan de secours, la position de la membrane cricothyroïdienne (MCT) doit être déterminée et marquée sur la peau au préalable, les études existantes indiquant le faible taux de réussite de la localisation de la MCT par palpation seulement. [20][21][22] Ainsi, si le temps le permet, une échographie doit être réalisée pour localiser la MCT. 23 Deux raisons peuvent justifier de renoncer à la sédation d'un patient éveillé présentant des voies aériennes fragilisées.…”

Section: La Mise Au Point D'un Plan De Prise En Charge à Partir Des Iunclassified

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Obstructing pathology of the upper airway in a post-NAP4 world: time to wake up to its optimal management

Law

Morris

Malpas

2017

Can J Anesth/J Can Anesth

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Section: Synthesizing a Plan From The Information Obtained From The Amentioning

confidence: 99%

Section: La Mise Au Point D'un Plan De Prise En Charge à Partir Des Iunclassified

Obstructing pathology of the upper airway in a post-NAP4 world: time to wake up to its optimal management

Law

Morris

Malpas

2017

Can J Anesth/J Can Anesth

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“…mettent de l'huile sur le feu de leur évaluation de la précision de localisation de la membrane cricothyroïdienne par palpation externe chez les patientes femmes. 2 Malgré leur supplément d'expérience en matière d'ouverture d'accès chirurgical d'urgence aux voies aériennes, les chirurgiens n'ont cependant pas réussi à démontrer un taux de réussite significativement plus élevé pour localiser la membrane cricothyroïdienne que leurs collègues anesthésiologistes -leur taux de réussite absolu n'était que de 26 %. En fait, dans l'étude de Hiller, le seul évaluateur à localiser correctement la membrane cricothyroïdienne chez les quatre patients à l'étude était un stagiaire en anesthésie de première année!…”

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“…2 Notwithstanding their greater experience in performing ESA, the surgeons failed to demonstrate a significantly better success rate at CTM identification than their anesthesia provider colleagues-their absolute success rate was only 26%. Indeed, the only assessor in the Hiller study to identify the CTM location correctly in all Work supported by the Department of Anesthesia, Dalhousie University.…”

mentioning

confidence: 97%

“…Now, as Hiller et al outline in this issue of the Journal, just north of the cricoid cartilage and sorely needed for expeditious emergency surgical airway (ESA), it seems that the cricothyroid membrane (CTM) is also keeping its exact location a closely guarded secret. 2 The ESA is infrequently performed by the average anesthesiologist and has had its issues. Historically, in a can't intubate, can't oxygenate (CICO) emergency, practitioners been slow to initiate the procedure.…”

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Deficiencies in locating the cricothyroid membrane by palpation: We can’t and the surgeons can’t, so what now for the emergency surgical airway?

Law

2016

Can J Anesth/J Can Anesth

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At times, it seems that we were never meant to discover the underlying mysteries of the neck's surface anatomy. The quest first began with the cricoid cartilage and although Sellick's maneuver 1 seemed an acceptable concept, it eventually proved somewhat disappointing in its application. Who knows how often this technique actually hit its target? Now, as Hiller et al. outline in this issue of the Journal, just north of the cricoid cartilage and sorely needed for expeditious emergency surgical airway (ESA), it seems that the cricothyroid membrane (CTM) is also keeping its exact location a closely guarded secret. 2The ESA is infrequently performed by the average anesthesiologist and has had its issues. Historically, in a can't intubate, can't oxygenate (CICO) emergency, practitioners been slow to initiate the procedure. Furthermore, some of the techniques used to execute the ESA have been less than effective, perhaps accounting for the generally poor success rates.3,4 Fortunately, recently published national airway guidelines address these matters with more definitive recommendations for both when and how ESA should occur.5-7 The trouble is, establishing an ESA generally begins with identifying the location of the CTM by external palpation. As it turns out, for the life of us (not to mention that of our patients), it seems that we can't reliably accomplish this task.At least six recently published studies from a variety of countries attest to this conclusion. [8][9][10][11][12][13] These studies used similar methodologies to determine how often physician assessors correctly identified the location of the CTM by external palpation. The assessors' estimations in these studies (and similarly in the present one) were compared with the actual location of the CTM as confirmed by ultrasound. In most studies, the assessor's attempt to localize the CTM was defined as a failure if the estimation was either outside the vertical confines of the CTM or [ 5 mm from the midline. The results are sobering. Correctly identifying the CTM location using external palpation is no better than a 50:50 proposition, give or take, even in nonobese subjects. Most of the studies include scatter plots of the assessors' estimates, and in some cases, localization is off by at least 3 cm above, below, or lateral to the actual CTM location. Not surprisingly, there is a trend towards worse results in females and obese subjects given their less distinct thyroid cartilage anatomy. These findings occurred in the relatively stress-free conditions of a clinical study in volunteer subjects. We can probably expect even worse results when we add the anxiety-related performance degradation in an actual CICO situation.By adding trauma surgeons to the mix, Hiller et al. add fuel to the fire with their study of the accuracy of CTM identification by external palpation in female subjects. 2Notwithstanding their greater experience in performing ESA, the surgeons failed to demonstrate a significantly better success rate at CTM identification than their anesthesia ...

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The effectiveness of educational methods for cricothyroid membrane identification by dental students: A prospective study using neck photographs and tracheotomy trainers

Goto

Kishimoto

Sakurai

2019

Clinical & Exp Dental Res

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The purpose of this study was to evaluate the accurate identification of the cricothyroid membrane (CTM) by fifth grade dental students, before undergoing the relevant anesthesiology practicum. Moreover, we aimed to determine the educational effectiveness of the cricothyrotomy practicum in anesthesiology. Before the lecture and without prior notification, 119 students were provided with a photograph of a man's neck and instructed to attach a blue sticker to the cricothyrotomy puncture site and to a palpable tracheotomy trainer, after applying sufficient palpation. After this, students attended a 60‐min lecture on the emergency airway management method. Two and 16 days after the lecture and practicum, students were presented with a new neck photograph and the tracheotomy trainer and asked again to place stickers (red stickers: at 2 days; green stickers: at 16 days) on the cricothyrotomy penetration site. The data were analyzed with an image processing software, by superimposing the 119 stickers on the neck photographs and tracheotomy trainers, to visually examine the accuracy of CTM identification. The rate of correct sticker placement in the neck photographs was 41.2% before the lecture, 80.7% 2 days after the lecture, and 77.3% 16 days after the lecture (before vs. 2 and 16 days after, p value < 0.01). For the tracheotomy trainer, the rate was 36.1% before the lecture, 97.5% 2 days after the lecture, and 94.1% 16 days after the lecture (before vs. 2 and 16 days after, p value < 0.01). Furthermore, the proportion of students with mistakes above and below the CTM was higher than that of students with mistakes to the right or left. In conclusion, the rate of accurate CTM identification among dental students was low before they underwent the relevant practicum, but most students were able to identify the CTM accurately after the lecture and practicum in a small class.

show abstract

Comparing success rates of anesthesia providers versus trauma surgeons in their use of palpation to identify the cricothyroid membrane in female subjects: a prospective observational study

Cited by 35 publications

References 31 publications

Obstructing pathology of the upper airway in a post-NAP4 world: time to wake up to its optimal management

Obstructing pathology of the upper airway in a post-NAP4 world: time to wake up to its optimal management

Deficiencies in locating the cricothyroid membrane by palpation: We can’t and the surgeons can’t, so what now for the emergency surgical airway?

The effectiveness of educational methods for cricothyroid membrane identification by dental students: A prospective study using neck photographs and tracheotomy trainers

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