Emergency front-of-neck access: scalpel or cannula'and the parable of Buridan's ass†

Greenland, K. B.; Bradley, William Pierre; Chapman, Gordan A.; Goulding, Gill; Irwin, Michael G.

doi:10.1093/bja/aex101

Cited by 28 publications

(18 citation statements)

References 30 publications

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“…Possible explanations are that recommendation for anesthesiologists to perform cricothyroidotomy as Front Of Neck Access (FONA) is recent or anesthesiologists are only publishing case reports as they rarely perform it during their careers or that the anesthesiologists are still not comfortable performing this procedure [4,44]. A recent editorial stated that there are many CICO situations in which trained surgeons are not readily available, and that the anesthesiologists, who are airway experts, should perform the emergency cricothyroidotomy [45]. Hence it is imperative that anesthesiologists be competent in this technique.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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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. The objective of this systematic review is to analyze complications following cricothyroidotomy and tracheostomy in airway emergencies. 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 7 days) and late (beyond 7 days of the procedure). Results: We retrieved 2659 references from our search criteria. Following the removal of duplicates, title and abstract review, 33 articles were selected for full-text reading. Twenty-one 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 finding supports the recommendations from the latest Difficult Airway Society (DAS) guidelines regarding using cricothyroidotomy as the technique of choice for emergency surgical airway. However, emergency cricothyroidotomies should be converted to tracheostomies in a timely fashion as there is insufficient evidence to suggest that emergency cricothyrotomies are long term airways.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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“…Possible explanations are that recommendation for anesthesiologists to perform cricothyroidotomy as Front Of Neck Access (FONA) is recent or anesthesiologists are only publishing case reports as they rarely perform it during their careers or that the anesthesiologists are still not comfortable performing this procedure [4,45]. A recent editorial stated that there are many CICO situations in which trained surgeons are not readily available, and that the anesthesiologists, who are airway experts, should perform the emergency cricothyroidotomy [46]. Hence it is imperative that anesthesiologists be competent in this technique.…”

Section: Discussionmentioning

confidence: 99%

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

Zasso

You-Ten

Ryu

et al. 2020

Preprint

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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.

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“…To date there is no high quality patient-centred randomised control trial comparing cannula with scalpel techniques and therefore the optimal technique for eFONA in a CICO situation is still debated. 19,20 Advocates for the scalpel cricothyroidotomy approach cite NAP4, which showed high success rates of surgical techniques and a high failure rate of cannula techniques. 1 Supporters of the cannula techniques highlight the low success rate by anaesthetists overall in NAP4 regardless of technique compared with surgeons who performed the majority of successful scalpel eFONAs.…”

Section: Debate On Optimal Efona Techniquementioning

confidence: 99%

Emergency front of neck access in airway management

Price

McCoy

2019

BJA Education

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Emergency front-of-neck access: scalpel or cannula'and the parable of Buridan's ass†

Cited by 28 publications

References 30 publications

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

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

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

Emergency front of neck access in airway management

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