Emergency Surgical Airways Following Activation of a Difficult Airway Management Team in Hospitalized Critically Ill Patients: A Case Series

Darby, Joseph M.; Halenda, Gregory M.; Chou, Courtney; Quinlan, Joseph J.; Alarcon, Louis H.; Simmons, Richard L.

doi:10.1177/0885066616680594

Cited by 15 publications

(29 citation statements)

References 54 publications

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“…The number of studies in each category is not additive. Five studies reported only tracheostomy complications [15][16][17][18][19]; 14 studies reported only cricothyroidotomy complications [20][21][22][23][24][25][26][27][28][29][30][31][32][33]; and two studies reported complications from both techniques (RCT included) [34,35].…”

Section: Resultsmentioning

confidence: 99%

“…In the TRACH group, three articles performed percutaneous [16,17,35], and four performed surgical approach [15,18,19,34]. In the CRICO group, only one article used percutaneous [35], one used both (13 procedures under percutaneous and 16 under surgical) [27], and all other used surgical technique [20][21][22][23][24][25][26][28][29][30][31][32][33][34] (Table 3).…”

Section: Resultsmentioning

confidence: 99%

“…In the CRICO group, the follow-up period varied from 24 h to 5 years. However, nine articles did not describe it [20, Each category is graded with a score of 1 (Yes) or 0 (No) 22,23,27,[29][30][31][32][33]. Two articles still reported late complications despite not specifying for how long patients were followed [22,27].…”

Section: Resultsmentioning

confidence: 99%

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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: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

et al. 2020

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Section: -Flow Chart)mentioning

confidence: 99%

“…In the CRICO group, the period varied from 24 hours to 5 years. However, nine articles did not describe it [20,22,23,27,[29][30][31][32][33]. Two articles still reported late complications despite not specifying the follow-up period [22,27].…”

Section: -Flow Chart)mentioning

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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Institution of a difficult airway response team for emergency department patients with anticipated or encountered difficult airways: Descriptive analysis of a 5‐year experience at an academic teaching hospital

Maldonado,

Thompson,

Srihari

et al. 2024

JACEP Open

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ObjectivesThis study aimed to describe characteristics and outcomes associated with difficult airway response team (DART) encounters in the emergency department (ED).MethodsWe performed a descriptive analysis of a prospective, single‐center database of DART encounters in the ED from April 1, 2016 to March 31, 2021 cross‐referenced with retrospective chart review. Adult ED patients ≥18 years old for whom a DART was activated were eligible. We prospectively collected activation characteristics, intubation indications, operator characteristics, and intubation methods used for DART encounters. Retrospective chart review was conducted to obtain patient demographics and outcome variables. Descriptive analyses were computed for all outcomes.ResultsWe analyzed 89 DART encounters. No intubation attempts were made prior to DART activation in 52 cases (58.4%). The most common indications for intubation were angioedema (n = 17, 19.1%) or other airway obstruction (n = 15, 16.9%). A definitive airway was established by anesthesiology (n = 46, 51.7%), emergency medicine (n = 25, 28.1%), trauma surgery (n = 9, 10.1%), and ENT (n = 5, 5.6%). The most common method of intubation used to establish a definitive airway was video laryngoscopy with a bougie or D‐blade (n = 29, 32.6%) followed by flexible fiberoptic intubation (n = 19, 21.3%). A surgical airway was required in eight encounters (cricothyrotomy [n = 4, 4.5%]; tracheostomy [n = 4, 4.5%]). Cases were managed in the ED (n = 73, 82%), operating room (OR) (n = 10, 11.2%), and intensive care unit (ICU) (n = 1, 1.1%). All patients requiring intubation had an endotracheal or surgical airway established.ConclusionOur findings provide important insights regarding ED DART utilization and have implications when considering institution of a DART in the ED.

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Emergency Surgical Airways Following Activation of a Difficult Airway Management Team in Hospitalized Critically Ill Patients: A Case Series

Cited by 15 publications

References 54 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

Institution of a difficult airway response team for emergency department patients with anticipated or encountered difficult airways: Descriptive analysis of a 5‐year experience at an academic teaching hospital

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