Percutaneous emergency airway access; prevention, preparation, technique and training

Kristensen, Michael Seltz; Teoh, Wendy H.; Baker, Paul

doi:10.1093/bja/aev029

Cited by 75 publications

(60 citation statements)

References 35 publications

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“…Performing a surgical airway with an open vs a percutaneous technique not only achieves higher success rates but also accomplishes the procedure in nearly half the time. 21 Based on this study and findings in recent literature, [22][23][24][25] we propose that clinicians should always pause before proceeding with an open cricothyrotomy to enable better identification of the anatomy within the initial wound. Although ultrasonography may be ideal for identifying the CTM, 26 we cannot assume its availability and universal clinical applicability, and therefore, it is not included in this discussion.…”

Section: Discussionmentioning

confidence: 74%

Comparing success rates of anesthesia providers versus trauma surgeons in their use of palpation to identify the cricothyroid membrane in female subjects: a prospective observational study

Hiller

Karni

Cai

et al. 2016

Can J Anesth/J Can Anesth

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Section: Discussionmentioning

confidence: 74%

Comparing success rates of anesthesia providers versus trauma surgeons in their use of palpation to identify the cricothyroid membrane in female subjects: a prospective observational study

Hiller

Karni

Cai

et al. 2016

Can J Anesth/J Can Anesth

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“…Cricothyroidotomy catheter complications described in case reports include subcutaneous emphysema from the catheter pulling out of the trachea, barotrauma with pneumothorax from a blocked upper airway and blockage from kinking [7,[10][11][12][13]. We Figure 4 On the left a 50 mm 14 G Optiva catheter showing the resting position after insertion into an opened trachea with contact between the tip and the mucosa.…”

Section: Discussionmentioning

confidence: 99%

Cricothyroidotomy catheters: an investigation of mechanisms of failure and the effect of a novel intracatheter stylet

2015

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SummaryEmergency catheter cricothyroidotomy often fails. Case reports have concentrated on kinking and displacement of the catheter as the major causes. We investigated catheter tip penetration of the trachea. Using insertion angles of 90°, 75°, 60°, 45°and 30°we advanced 14 G intravenous catheters into fresh isolated sheep tracheas during high pressure oxygen insufflation. At all angles, the catheter tip became blocked by pushing into the mucosa with submucosal gas injection on one or more attempts. Full thickness rupture with extratracheal gas also occurred on insertions at 90°and 60°. We then tested a Luer-mounted prototype wire stylet which remains in situ during insufflation. Using the same methodology, the stylet was able to be placed and prevented blockage at all angles of insertion. Mucosal trauma and submucosal gas injection occurred on insertions at 90°and 75°. Our results should guide further stylet design.

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“…A smallbore cannula technique has a high failure rate, especially in obese patients [45]. A surgical airway provides a definitive airway and has a higher success rate [148]. Ultrasound of the neck may be a useful aid to locate the correct site for front-of-neck access, even as an emergency procedure [149].…”

Section: Front-of-neck Proceduresmentioning

confidence: 99%

Obstetric Anaesthetists’ Association and Difficult Airway Society Guidelines for the Management of Difficult and Failed Tracheal Intubation in Obstetrics

Mushambi¹,

Kinsella²,

Popat³

et al. 2016

Obstetric Anesthesia Digest

114

221

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SummaryThe Obstetric Anaesthetists' Association and Difficult Airway Society have developed the first national obstetric guidelines for the safe management of difficult and failed tracheal intubation during general anaesthesia. They comprise four algorithms and two tables. A master algorithm provides an overview. Algorithm 1 gives a framework on how to optimise a safe general anaesthetic technique in the obstetric patient, and emphasises: planning and multidisciplinary communication; how to prevent the rapid oxygen desaturation seen in pregnant women by advocating nasal oxygenation and mask ventilation immediately after induction; limiting intubation attempts to two; and consideration of early release of cricoid pressure if difficulties are encountered. Algorithm 2 summarises the management after declaring failed tracheal intubation with clear decision points, and encourages early insertion of a (preferably secondgeneration) supraglottic airway device if appropriate. Algorithm 3 covers the management of the 'can't intubate, can't oxygenate' situation and emergency front-of-neck airway access, including the necessity for timely perimortem caesarean section if maternal oxygenation cannot be achieved. Table 1 gives a structure for assessing the individual factors relevant in the decision to awaken or proceed should intubation fail, which include: urgency related to maternal or fetal factors; seniority of the anaesthetist; obesity of the patient; surgical complexity; aspiration risk; potential difficulty with provision of alternative anaesthesia; and post-induction airway device and airway patency. This decision should be considered by the team in advance of performing a general anaesthetic to make a provisional plan should failed intubation occur. The table is also intended to be used as a teaching tool to facilitate discussion and learning regarding the complex nature of decision-making when faced with a failed intubation. Table 2 gives practical considerations of how to awaken or proceed with surgery. The background paper covers recommendations on drugs, new equipment, teaching and training.

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Percutaneous emergency airway access; prevention, preparation, technique and training

Cited by 75 publications

References 35 publications

Comparing success rates of anesthesia providers versus trauma surgeons in their use of palpation to identify the cricothyroid membrane in female subjects: a prospective observational study

Comparing success rates of anesthesia providers versus trauma surgeons in their use of palpation to identify the cricothyroid membrane in female subjects: a prospective observational study

Cricothyroidotomy catheters: an investigation of mechanisms of failure and the effect of a novel intracatheter stylet

Obstetric Anaesthetists’ Association and Difficult Airway Society Guidelines for the Management of Difficult and Failed Tracheal Intubation in Obstetrics

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