Emergency cricothyrotomy: temporary measure or definitive airway? A systematic review.

Macêdo, Marina Barguil; Guimarães, Ruggeri Bezerra; Ribeiro, Sahâmia Martins; Sousa, Kátia Maria Marabuco de

doi:10.1590/0100-69912016006010

Cited by 20 publications

(18 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Once stabilized, the airway will need conversion to tracheal tube or tracheostomy. 11,237 Pharyngeal or oesophageal injury may have occurred, with potential for mediastinal infection and may require further investigation. 223…”

Section: Management Following Fonamentioning

confidence: 99%

Guidelines for the management of tracheal intubation in critically ill adults

Higgs

McGrath²,

Goddard

et al. 2018

British Journal of Anaesthesia

598

521

View full text Add to dashboard Cite

These guidelines describe a comprehensive strategy to optimize oxygenation, airway management, and tracheal intubation in critically ill patients, in all hospital locations. They are a direct response to the 4 National Audit Project of the Royal College of Anaesthetists and Difficult Airway Society, which highlighted deficient management of these extremely vulnerable patients leading to major complications and avoidable deaths. They are founded on robust evidence where available, supplemented by expert consensus opinion where it is not. These guidelines recognize that improved outcomes of emergency airway management require closer attention to human factors, rather than simply introduction of new devices or improved technical proficiency. They stress the role of the airway team, a shared mental model, planning, and communication throughout airway management. The primacy of oxygenation including pre- and peroxygenation is emphasized. A modified rapid sequence approach is recommended. Optimal management is presented in an algorithm that combines Plans B and C, incorporating elements of the Vortex approach. To avoid delays and task fixation, the importance of limiting procedural attempts, promptly recognizing failure, and transitioning to the next algorithm step are emphasized. The guidelines recommend early use of a videolaryngoscope, with a screen visible to all, and second generation supraglottic airways for airway rescue. Recommendations for emergency front of neck airway are for a scalpel-bougie-tube technique while acknowledging the value of other techniques performed by trained experts. As most critical care airway catastrophes occur after intubation, from dislodged or blocked tubes, essential methods to avoid these complications are also emphasized.

show abstract

Section: Management Following Fonamentioning

confidence: 99%

Guidelines for the management of tracheal intubation in critically ill adults

Higgs

McGrath²,

Goddard

et al. 2018

British Journal of Anaesthesia

598

521

View full text Add to dashboard Cite

show abstract

“…In 1921 Jackson described that, in a series of 200 patients, nearly 80% of tracheal stenosis were secondary to the previous cricothyrotomy, warning against its use even in case of ESA necessity [34]. 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.…”

Section: Esa: Should Emergency Tracheotomy Be Preferred Over Cricothymentioning

confidence: 99%

Emergency surgical tracheotomy in the era of COVID-19 pandemic

Muriana¹,

Ciriaco²,

Carretta³

et al. 2021

View full text Add to dashboard Cite

At the beginning of 2020 a novel variant of coronavirus, named SARS-CoV-2, was identified as responsible for the development of severe pneumonia and acute respiratory distress syndrome (ARDS) with very high mortality, exceeding 30%. The disease caused by SARS-CoV-2, called Coronavirus Disease 2019 (COVID-19), was declared a pandemic by WHO on March 11th, 2020. Patients affected by COVID-19 may present with subtle, specific symptoms, but the sudden onset of life-threatening acute respiratory failure is not uncommon. The peculiarities of the disease combined with the single patient’s comorbidities, e.g. advanced age and cardiovascular diseases, plus hypoxia and hypotension secondary to ARDS, and multiorgan failure, may lead to unexpected difficulties in the case of tracheal intubation. The occurrence of the ‘Cannot-Intubate-Cannot-Oxygenate’ (CICO) scenario in COVID-19 patients represents a hazard not only for the patients but also for the assisting healthcare workers due to the high risk of aerosol-generating infected particles during conventional rescue airway procedures. While international consensus guidelines on the management of CICO scenario in COVID-19 patients are still lacking, there is evidence that both scalpel cricothyrotomy (CT) and open surgical tracheotomy (OST) represent valid alternatives for the establishment of a front-of-neck emergency airway. Primary CT requires a staged conversion to formal tracheotomy; conversely, OST represents a definitive mastery of the airway in COVID-19 patients in case of prolonged mechanical ventilation dependency, avoiding a second procedure and further exposure to aerosols. Furthermore, in patients with facial trauma and/or head and neck tumors, OST allows obtaining safe airway control. In the context of the current pandemic, emergency OST procedure in SARS-CoV-2 positives (or with unknown status) requires adequate arrangements and the use of proper personal protective equipment to limit risks for clinicians.

show abstract

“…Traditionally, CTT was converted to formal TS within 72 h [33,38]. This statement was based upon the historical assumption that CTT is associated with an extremely high risk of subglottic stenosis [39].…”

Section: Conversion To Tracheostomymentioning

confidence: 99%

“…Moreover, there seems to be no significant difference in the complication rates of CTT and TS [ 41 ], while the incidence of late complications might be even higher with TS compared to CTT (25.1% vs. 13.6%) [ 33 ]. Various studies report the rate of conversion for CTT as ranging from 0–100% [ 38 ], without differences in terms of long-term benefits between the conversion and permanence of CTT [ 42 , 43 ]. However, considering the lack of experience of personnel in the postoperative care of CTT in comparison to TS in our wards as well as the higher risk of CTT cannula dislodgement and/or occlusion, in our opinion, conversion to a formal TS is strongly suggested.…”

Section: Commentsmentioning

confidence: 99%

Emergent tracheostomy during the pandemic of COVID-19: Slovenian National Recommendations

Šifrer

Urbančič

Piazza

et al. 2020

Eur Arch Otorhinolaryngol

View full text Add to dashboard Cite

Purpose Emergent tracheostomy under local anaesthesia is a reliable method of airway management when orotracheal intubation is not possible. COVID-19 is spread through aerosol making the emergent tracheostomy a high-risk procedure for surgeons. The surgical establishment of the air conduit in emergency scenarios must be adjusted for safety reasons. Methods To establish the Slovenian National Guidelines for airway management in cannot intubate-cannot ventilate situations in COVID-19 positive patients. Results Good communication and coordination between surgeon and anaesthesiologist is absolutely necessary. Deep general anaesthesia, full muscle relaxation and adequate preoxygenation without intubation are initial steps. The surgical cricothyrotomy is performed quickly, the thin orotracheal tube is inserted, the cuff is inflated and ventilation begins. Following patient stabilisation, the conversion to the tracheostomy is undertaken with the following features: skin infiltration with vasoconstrictor, a vertical incision, avoidance of electrical devices in favour of classical manners of haemostasis, the advancement of the tube towards the carina, performing the tracheal window in complete apnoea following adequate oxygenation, the insertion of non-fenestrated canulla attached to a heat and moisture exchanger, the fixation of canulla with stitches and tapes, and the cricothyrotomy entrance closure. Appropriate safety equipment is equally important. Conclusion The goal of the guidelines is to make the procedure safer for medical teams, without harming the patients. Further improvements of the guidelines will surely appear as COVID-19 is a new entity and there is not yet much experience in handling it.

show abstract

Emergency cricothyrotomy: temporary measure or definitive airway? A systematic review.

Cited by 20 publications

References 23 publications

Guidelines for the management of tracheal intubation in critically ill adults

Guidelines for the management of tracheal intubation in critically ill adults

Emergency surgical tracheotomy in the era of COVID-19 pandemic

Emergent tracheostomy during the pandemic of COVID-19: Slovenian National Recommendations

Contact Info

Product

Resources

About