Cricothyrotomy Is Faster Than Tracheostomy for Emergency Front-of-Neck Airway Access in Dogs

Abstract

Objectives: In novice final year veterinary students, we sought to: (1) compare the procedure time between a novel cricothyrotomy (CTT) technique and an abbreviated tracheostomy (TT) technique in canine cadavers, (2) assess the success rate of each procedure, (3) assess the complication rate of each procedure via a damage score, (4) evaluate the technical difficulty of each procedure and (5) determine the preferred procedure of study participants for emergency front-of-neck access.Materials and Methods: A prospective, cross-over, block randomised trial was performed, where veterinary students completed CTT and TT procedures on cadaver dogs. Eight students were recruited and performed 32 procedures on 16 dogs. A generalised estimating equation approach to modelling the procedure times was used.Results: The procedure time was significantly faster for the CTT than the TT technique, on average (p < 0.001). The mean time taken to complete the CTT technique was 49.6 s (95% CI: 29.5–69.6) faster on average, with a mean CTT time of less than half that of the TT. When taking into account the attempt number, the procedure time for a CTT was 66.4 s (95% CI: 38.9–93.9) faster than TT for the first attempt, and for the second attempt, this was 32.7 s (95% CI: 15.2–50.2) faster, on average. The success rate for both procedures was 100% and there was no difference detected in the damage or difficulty scores (P = 0.13 and 0.08, respectively). Seven of eight participants preferred the CTT.Clinical Significance: CTT warrants consideration as the primary option for emergency front-of-neck airway access for dogs.

A Proposed Guideline for Performance of Emergency Surgical Airways in Small Animals: Analysis of Five Unsuccessfully Managed Cannot Intubate, Cannot Oxygenate Cases

“…In veterinary medicine, a novel scalpel-bougie cricothyrotomy technique has recently been described which may make eFONA more achievable for veterinarians [16]. The technique uses only a scalpel, urinary catheter and endotracheal tube and was found to be significantly faster and easier than a slash tracheostomy [17].…”

Prehospital Emergency Cricothyrotomy in Dogs Part 1: Experiences With Commercial Cricothyrotomy Kits

“…Despite this, the CTT is the procedure of choice during CICO emergencies in human medicine ( 29 ). It has also recently been shown to allow adequate ventilation in a porcine model ( 27 ) and demonstrated faster placement times compared with TT with 100% accuracy in dogs ( 12 ). Access to equipment such as these CTT kits, and knowledge of their application, is essential for life-saving interventions for CICO situations in operational K9s and MWD in the prehospital setting.…”

“…When compared with TT, CTT is the faster technique when performed by novices ( 12 ). Due to its relative simplicity, CTT is likely a more readily retainable skill that may be more easily applied by HCPs with limited surgical training or those not performing advanced airway techniques regularly.…”

“…A previous study validated the effectiveness of the laryngeal handshake technique in dogs. In that study, novice veterinary students achieved 100% success rate in placing tube CTTs in cadaver dogs when using the laryngeal handshake technique ( 12 ). The technique described in the aforementioned study is as follows:…”

“…Traditionally, most references listed the tube tracheostomy (TT) as the only advised procedure for emergency front of neck airway access (eFONA) in MWDs ( 2 ), however, recommendations published within the last few years now include the CTT as a viable prehospital eFONA option for dogs ( 11 ). A recent veterinary study concluded CTT had a success rate of 100% and was faster and easier to perform when compared to TT in cadaver dogs ( 12 ). Although the requirement for a CTT in the prehospital, battlefield setting is relatively rare in people, it can be an immediately life-saving intervention ( 13 – 15 ).…”