Structured approach to ultrasound-guided identification of the cricothyroid membrane: a randomized comparison with the palpation method in the morbidly obese

Kristensen, Michael Seltz; Teoh, Wendy H.; Rudolph, Søren Steemann; Tvede, Michael; Hesselfeldt, Rasmus; Børglum, Jens; Lohse, Thomas; Hansen, Lars Nikolaj

doi:10.1093/bja/aev123

Cited by 68 publications

(57 citation statements)

References 5 publications

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“…On the basis of a mean (SD) 55.4 (24.1) s to locate the cricothyroid membrane , we calculated that 40 anaesthetists were needed to detect a one‐third difference in time to identification of the cricothyroid membrane, with a power of 90% and a significance level of p < 0.05 . We decided to include 45 anaesthetists in case of drop‐outs.…”

Section: Methodsmentioning

confidence: 99%

“…Both techniques significantly increase the success rate of identifying the cricothyroid membrane as compared with palpation. With the longitudinal technique, it took a median 48 s in morbidly obese individuals to correctly identify the cricothyroid membrane . For this reason, the technique is mainly recommended to identify the cricothyroid membrane before initiation of airway management .…”

Section: Introductionmentioning

confidence: 99%

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A randomised cross-over comparison of the transverse and longitudinal techniques for ultrasound-guided identification of the cricothyroid membrane in morbidly obese subjects

Kristensen

Teoh²,

Rudolph

et al. 2016

Anaesthesia

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A randomised cross-over comparison of the transverse and longitudinal techniques for ultrasound-guided identification of the cricothyroid membrane in morbidly obese subjects SummaryWe compared the transverse and longitudinal approaches to ultrasound-guided identification of the cricothyroid membrane, to determine which was faster and more successful. Forty-two anaesthetists received a one-hour structured training programme consisting of e-learning, a lecture and hands-on training, and then applied both techniques in a randomised, cross-over sequence to obese females with body mass index 39.0 -43.9 kg.m À2. The mean (SD) time to identify the cricothyroid membrane was 24.0 (12.4) s using the transverse technique compared with 37.6 (17.9) s for the longitudinal technique (p = 0.0003). Successful identification of the cricothyroid membrane was achieved by 38 (90%) anaesthetists using either technique. All anaesthetists were successful in identifying the cricothyroid membrane with at least one of the techniques. We advocate the learning and application of these two techniques for identification of the cricothyroid membrane before starting anaesthesia in difficult patients, especially when anatomical landmarks are impalpable. Further use in emergency situations is feasible, if clinicians have experience and the ultrasound machine is readily available.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A randomised cross-over comparison of the transverse and longitudinal techniques for ultrasound-guided identification of the cricothyroid membrane in morbidly obese subjects

Kristensen

Teoh²,

Rudolph

et al. 2016

Anaesthesia

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“…6,7 Ultrasonography, despite being slower, has higher accuracy, and is now considered feasible to use during an airway emergency. 4,7,8 We tested if a new two-level transverse airway ultrasonography technique to localise the cricothyroid membrane is faster than the current fastest ultrasonography technique, the 'transverse-airline-cricoid-airline' (TACA) technique, in obese females. 4 Accuracy of both techniques was also assessed and compared.…”

Section: Declarations Of Interestmentioning

confidence: 99%

Comparison of two transverse airway ultrasonography techniques for speed and accuracy to localise the cricothyroid membrane in obese female volunteers

Gadd

Kwok²,

Sidhu³

et al. 2019

British Journal of Anaesthesia

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“…[8][9][10][11][12][13] Ces études se fondent sur des méthodologies semblables afin de déterminer la fréquence à laquelle les médecins évaluateurs ont correctement localisé la membrane cricothyroïdienne par palpation externe. Les estimations des évaluateurs dans ces études (tout comme dans l'étude publiée ici) ont été comparées à Deficiencies in locating the cricothyroid membrane by palpation 793 l'emplacement réel de la membrane cricothyroïdienne déterminé par échoguidage.…”

Section: Incapables De Localiser Launclassified

“…[8][9][10][11][12][13] These studies used similar methodologies to determine how often physician assessors correctly identified the location of the CTM by external palpation. The assessors' estimations in these studies (and similarly in the present one) were compared with the actual location of the CTM as confirmed by ultrasound.…”

mentioning

confidence: 99%

Deficiencies in locating the cricothyroid membrane by palpation: We can’t and the surgeons can’t, so what now for the emergency surgical airway?

Law

2016

Can J Anesth/J Can Anesth

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At times, it seems that we were never meant to discover the underlying mysteries of the neck's surface anatomy. The quest first began with the cricoid cartilage and although Sellick's maneuver 1 seemed an acceptable concept, it eventually proved somewhat disappointing in its application. Who knows how often this technique actually hit its target? Now, as Hiller et al. outline in this issue of the Journal, just north of the cricoid cartilage and sorely needed for expeditious emergency surgical airway (ESA), it seems that the cricothyroid membrane (CTM) is also keeping its exact location a closely guarded secret. 2The ESA is infrequently performed by the average anesthesiologist and has had its issues. Historically, in a can't intubate, can't oxygenate (CICO) emergency, practitioners been slow to initiate the procedure. Furthermore, some of the techniques used to execute the ESA have been less than effective, perhaps accounting for the generally poor success rates.3,4 Fortunately, recently published national airway guidelines address these matters with more definitive recommendations for both when and how ESA should occur.5-7 The trouble is, establishing an ESA generally begins with identifying the location of the CTM by external palpation. As it turns out, for the life of us (not to mention that of our patients), it seems that we can't reliably accomplish this task.At least six recently published studies from a variety of countries attest to this conclusion. [8][9][10][11][12][13] These studies used similar methodologies to determine how often physician assessors correctly identified the location of the CTM by external palpation. The assessors' estimations in these studies (and similarly in the present one) were compared with the actual location of the CTM as confirmed by ultrasound. In most studies, the assessor's attempt to localize the CTM was defined as a failure if the estimation was either outside the vertical confines of the CTM or [ 5 mm from the midline. The results are sobering. Correctly identifying the CTM location using external palpation is no better than a 50:50 proposition, give or take, even in nonobese subjects. Most of the studies include scatter plots of the assessors' estimates, and in some cases, localization is off by at least 3 cm above, below, or lateral to the actual CTM location. Not surprisingly, there is a trend towards worse results in females and obese subjects given their less distinct thyroid cartilage anatomy. These findings occurred in the relatively stress-free conditions of a clinical study in volunteer subjects. We can probably expect even worse results when we add the anxiety-related performance degradation in an actual CICO situation.By adding trauma surgeons to the mix, Hiller et al. add fuel to the fire with their study of the accuracy of CTM identification by external palpation in female subjects. 2Notwithstanding their greater experience in performing ESA, the surgeons failed to demonstrate a significantly better success rate at CTM identification than their anesthesia ...

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Structured approach to ultrasound-guided identification of the cricothyroid membrane: a randomized comparison with the palpation method in the morbidly obese

Abstract: Ultrasound assessment of gastric volume in the fasted pediatric patient undergoing upper gastrointestinal endoscopy: development of a predictive model using endoscopically suctioned volumes.

Cited by 68 publications

References 5 publications

A randomised cross-over comparison of the transverse and longitudinal techniques for ultrasound-guided identification of the cricothyroid membrane in morbidly obese subjects

A randomised cross-over comparison of the transverse and longitudinal techniques for ultrasound-guided identification of the cricothyroid membrane in morbidly obese subjects

Comparison of two transverse airway ultrasonography techniques for speed and accuracy to localise the cricothyroid membrane in obese female volunteers

Deficiencies in locating the cricothyroid membrane by palpation: We can’t and the surgeons can’t, so what now for the emergency surgical airway?

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