Equipment and strategies for emergency tracheal access in the adult patient

Abstract

SummaryThe inability to maintain oxygenation by non‐invasive means is one of the most pressing emergencies in anaesthesia and emergency care. To prevent hypoxic brain damage and death in a ‘cannot intubate, cannot oxygenate’ situation, emergency percutaneous airway access must be performed immediately. Even though this emergency is rare, every anaesthetist should be capable of performing an emergency percutaneous airway as the situation may arise unexpectedly. Clear knowledge of the anatomy and the insertion technique, and repeated skill training are essential to ensure completion of this procedure rapidly and successfully. Various techniques have been described for emergency oxygenation and several commercial emergency cricothyroidotomy sets are available. There is, however, no consensus on the best technique or device. As each has its limitations, it is recommended that all anaesthetists are skilled in more than one technique of emergency percutaneous airway. Avoiding delay in initiating rescue techniques is at least as important as choice of device in determining outcome.

Evaluation of a novel Surgicric® cricothyroidotomy device for emergency tracheal access in a porcine model

“…As a procedure, it is fraught with potential hazards, and, even when successful, subsequent use to maintain oxygenation is not without risk [2,3]. One alternative is the surgical technique, but this has the potential to be hazardous, and if bleeding occurs may render the airway irretrievable.…”

Evaluation of Alternative Airway Devices in University and Educational and Research Hospital Emergency Departments in Turkey

“…The limited use of these devices in our hospitals may be because their widespread use has been described only in recent years and their high prices. The requirement for a surgical airway intervention after unsuccessful intubation is approximately 0.8%, and this rate increases to 11% in pre-hospital intubation (42,43). Percutaneous cricothyrotomy using the Seldinger technique is faster when compared with surgical cricothyrotomy, and the success rates of each technique range from 60% to 100% (43).…”

“…The requirement for a surgical airway intervention after unsuccessful intubation is approximately 0.8%, and this rate increases to 11% in pre-hospital intubation (42,43). Percutaneous cricothyrotomy using the Seldinger technique is faster when compared with surgical cricothyrotomy, and the success rates of each technique range from 60% to 100% (43). The surgical and percutaneous cricothyrotomy equipments used in rescue methods, when ventilation and oxygenation cannot be provided, are available in emergency departments of our hospitals at the rate of 50%.…”

Elective IntubationDiscussion

“…Prevention of lethal hypoxemia by applying extraordinary airway techniques, including surgical airway access, is mandatory and must be a part of all elective airway management plans. 11 Physical examination of patients and their airways should help identify predictors of difficult ventilation or intubation. In a large study of over 53,000 general anesthetics, 77 (0.15%) patients could not be ventilated by mask or with a simple airway adjuvant.…”