Prevalence of major vessels anterior to the trachea at sites of potential front-of-neck emergency airway access in adults

Weightman, William M.; Gibbs, N. M.

doi:10.1016/j.bja.2018.07.013

Cited by 27 publications

(20 citation statements)

References 28 publications

(16 reference statements)

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“…However, they report a BCT position range of 2.7–0.8 cm in relation to the sternal notch, while our results included ranges between 3.10 and − 3.50 cm at the midline, and 4.50 and − 1.60 cm MHFE. Weightman and Gibbs [ 25 ] examined 500 CT of adult patients, identifying 53% (n 264) has a large vessel (brachiocephalic artery, right carotid artery, left carotid artery and unnamed left and right veins) anterior to the trachea in the anterior triangle of the neck. The most common was the BCT (38.2%, n 191) bifurcating above the suprasternal notch, but none of them reached the cricothyroid membrane.…”

Section: Discussionmentioning

confidence: 99%

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Anatomical and positional variants of the brachiocephalic trunk in a Mexican population

et al. 2021

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Background Brachiocephalic trunk (BCT) variants may have a clinical impact during surgical procedures, some of which could be fatal. The objective of this study was to classify height positions of the BCT and report their prevalence in a Mexican population. Methods Patients: A retrospective, descriptive, observational, and cross-sectional was performed using computed tomography angiography (CTA) of adult (> 18 years of age) patients, without gender distinction, of Mexican origin. Measuring techniques were standardized using the suprasternal notch to analyze linear and maximum heights, linear and curved lengths, and the vertebral origin and bifurcation levels of the BCT. Results A total of 270 CTA were obtained (66.7% men and 33.3% women). A high position of BCT was present in 64.81% (n 175/270). The mean linear medial height was 0.58 ± 1.91 cm, the maximum height of the free edge was 3.85 ± 2.04 cm, side length of the midline at the maximum height of the free edge was 1.46 ± 2.59, linear length 3.72 ± 0.70, and a curve length 3.99 ± 0.79. The BCT origin was most predominant at the T3 (57.9%) and T4 (27.0%) vertebral levels, with the bifurcation at T2 (57.9%) and T1 (36.2%). Conclusions There is a high prevalence of high position BCT in our population. Patients should be assessed before any procedures in the area, due to the potential risk of complications.

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Section: Discussionmentioning

confidence: 99%

“…For this reason, the suprasternal notch has been proposed as an anatomical landmark [ 17 ]. The risk of bias should also be considered, as many studies do not report inter- or intra-observer reliability coefficients for their measurements [ 17 , 25 ].…”

Section: Introductionmentioning

confidence: 99%

Anatomical and positional variants of the brachiocephalic trunk in a Mexican population

et al. 2021

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“…11 A major vessel may be found anterior to the trachea, and this is most likely in the suprasternal notch. 17 However, imaging may not always be possible in acute emergencies; thus, an ENT surgeon, and an airway surgeon in particular, should be aware of the various possible vascular anatomical variations of the great vessels of the neck.…”

Section: Discussionmentioning

confidence: 99%

Anomalous innominate artery complicating tracheal surgical procedures

et al. 2021

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Objective To highlight the importance of imaging in reducing an accidental injury to the anomalous brachiocephalic trunk and its branches during tracheal surgery. Case report This paper reports two cases of accidental injury to the great vessels in the neck during tracheal surgery. The first incident occurred during a repeat tracheostomy, when the right common carotid artery was injured. On reviewing the computed tomography images, the bifurcation of the brachiocephalic artery was seen to the left of the midline, and the right common carotid artery was adherent just below the tracheostomy site. The second incident happened during surgery for tracheal stenosis, when there was an inadvertent injury to the main brachiocephalic trunk, which was adherent to the trachea in the lower neck region. Conclusion For airway surgeons, radiological assessment of vascular structures in relation to the trachea prior to surgery is as important as the endoluminal airway assessment for the best outcome.

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“…Our study reconfirmed the impression that the scalpel technique is associated with a higher risk of severe vascular injury [25,27,28] which occurred during a stab incision through cricothyroid membrane when the scalpel blade slid laterally and lacerated the carotid artery. However, the great vessels at the level of cricothyroid membrane in the pig are positioned more medially representing a higher risk of injury as compared to those in humans [29] where no major vessels are found anterior to the cricothyroid membrane [30]. Furthermore, the cricoid cartilage injury may result in a long-term complication such as stenosis.…”

Section: Plos Onementioning

confidence: 99%

Rescue oxygenation success by cannula or scalpel-bougie emergency front-of-neck access in an anaesthetised porcine model

et al. 2020

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In the obese, the evidence for the choice of the optimal emergency front-of-neck access technique is very limited and conflicting. We compared cannula and scalpel-bougie emergency front-of-neck access techniques in an anaesthetised porcine model with thick pretracheal tissue. Cannula and scalpel-bougie cricothyroidotomy techniques were performed in 11 and 12 anaesthetised pigs, respectively. Following successful tracheal access, oxygenation was commenced and continued for 5 min using Rapid-O2 device for cannula and circle breathing system for scalpel-bougie study groups. The primary outcome was a successful rescue oxygenation determined by maintenance of arterial oxygen saturation >90% 5 min after the beginning of oxygenation. Secondary outcomes included success rate of airway device placement, time to successful airway device placement, and trauma to the neck and airway. The success rate of rescue oxygenation was 18% after cannula, and 83% after scalpel-bougie technique (P = 0.003). The success rate of airway device placement was 73% with cannula and 92% with scalpel-bougie technique (P = 0.317). Median (inter-quartilerange) times to successful airway device placement were 108 (30-256) and 90 (63-188) seconds (P = 0.762) for cannula and scalpel-bougie emergency front-of-neck access, respectively. Proportion of animals with iatrogenic trauma additional to the procedure itself was 27% for cannula and 75% for scalpel-bougie technique (P = 0.039). Thus, in the porcine model of obesity, the scalpel-bougie technique was more successful in establishing and maintaining rescue oxygenation than cannula-based technique; however, it was associated with a higher risk of severe trauma.

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Prevalence of major vessels anterior to the trachea at sites of potential front-of-neck emergency airway access in adults

Cited by 27 publications

References 28 publications

Anatomical and positional variants of the brachiocephalic trunk in a Mexican population

Anatomical and positional variants of the brachiocephalic trunk in a Mexican population

Anomalous innominate artery complicating tracheal surgical procedures

Rescue oxygenation success by cannula or scalpel-bougie emergency front-of-neck access in an anaesthetised porcine model

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