Complications of cricothyroidotomy versus tracheostomy in emergency surgical airway management: A systematic review

Abstract

Background Airway guidelines recommend an emergency surgical airway as a potential life-saving treatment in a “Can’t Intubate, Can’t Oxygenate” (CICO) situation. Surgical airways can be achieved either through a cricothyroidotomy or tracheostomy. The current literature has limited data regarding complications of cricothyroidotomy and tracheostomy in an emergency situation, such as in a CICO scenario. The objective of this systematic review is to analyze complications following cricothyroidotomy and tracheostomy in this situation. Methods This synthesis of literature was exempt from ethics approval. Eight databases were searched from inception to October 2018, using a comprehensive search strategy. Studies were included if they were randomized controlled trials or observational studies reporting complications following emergency surgical airway. Complications were classified as minor (evolving to spontaneous remission or not requiring intervention or not persisting chronically), major (requiring intervention or persisting chronically), early (from the start of the procedure up to seven days) and late (beyond seven days of the procedure). Results We retrieved 2,659 references from our search criteria. Following the removal of duplicates, title and abstract review, 33 articles were selected for full-text reading. 21 articles were finally included in the systematic review. We found no differences in minor, major or early complications between the two techniques. However, late complications were significantly more frequent in the tracheostomy group [OR (95% CI) 0.21 (0.20-0.22), p<0.0001]. Conclusions Our results demonstrate that cricothyroidotomies performed in emergent situations resulted in fewer late complications than tracheostomies. This may be indicative that cricothyroidotomy is safer than tracheostomy as an emergency surgical airway. This finding supports the recommendations from the latest Difficult Airway Society (DAS) guidelines regarding using cricothyroidotomy as the technique of choice for emergency surgical airway in a CICO situation.

Emergency surgical tracheotomy in the era of COVID-19 pandemic

“…This is why conversion of emergency CT into a formal tracheostomy within 3 days has been suggested to avoid the establishment of pathologic mechanisms leading to the development of subglottic stenosis [35]. Since then, several studies later demonstrated a significant reduction in the risk of such postoperative complication [36,37], and current ATLS [24] and DAS guidelines [22] suggest surgical CT as a rescue procedure of choice for the establishment of an ESA in the CICO scenario. Compared to OST, CT is thought to be faster and burdened by a lower incidence of intraoperative complications [38].…”

“…The incidence of perioperative complications between CT and OST in the emergency was compared in some reports. Referring to OST, higher rates of intraoperative bleeding and postoperative peristomal infections have been mentioned [39], as well as a moderately higher frequency of generic late and overall complications [37].…”