The Bougie-Aided Cricothyrotomy

Braude, Darren; Webb, Heather R.; Stafford, Jennifer; Stulce, Paula; Montanez, Lauri; Kennedy, George A.; Grimsley, David

doi:10.1016/j.amj.2009.02.001

Cited by 17 publications

(11 citation statements)

References 25 publications

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“…Early in our series, in keeping with early Advanced Trauma Life Support teaching, 16 we did use the scalpel handle or artery forceps to dilate the wound on 5/24 occasions, but since have come to prefer the tip of the operator's little finger. As described by other authors, 19,20 we also used an intubating bougie to assist in feeding the endotracheal tube on 5/24 occasions, once without clear clinical need, and four times upon finding difficulty feeding the endotracheal tube. On one occasion, this difficulty was encountered because our initial incision was too small, and on three others because the larynx was excessively swollen because of injury or infection.…”

Section: Resultsmentioning

confidence: 99%

“…Cricothyroidotomy for acute airways obstruction is now acknowledged as not only a safe technique, 14 but, because of the superficial nature of the cricothyroid membrane, one that is faster and simpler than formal tracheostomy 2,3,10,24 . It is now widely accepted that cricothyroidotomy is the procedure of choice for emergency surgical access to the airway, and a variety of techniques have been described 6–8,17,18,20,22,25 …”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Emergency surgical cricothyroidotomy: 24 successful cases leading to a simple ‘scalpel–finger–tube’ method

Paix¹,

Griggs²

2011

Emerg Medicine Australasia

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Surgical airway access justifiably remains the final option for managing the 'can't intubate can't ventilate' situation, but available techniques are often complicated and might require special equipment. This paper reports on the real world experience of two experienced Australian medical specialists with backgrounds in Anaesthesia and Aeromedical Retrieval who performed 24 surgical airways, mainly under adverse prehospital conditions, over a combined 40 years of practice. All attempts were successful, the majority through a simple open 'scalpel-finger-tube' method, which is described here.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Emergency surgical cricothyroidotomy: 24 successful cases leading to a simple ‘scalpel–finger–tube’ method

Paix¹,

Griggs²

2011

Emerg Medicine Australasia

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“…Other instruments needed for the procedure may include a tracheal hook, a Trousseau dilator, or a tracheal tube introducer. 183 …”

Section: Management Of the Difficult And Failed Airway In The Unconscmentioning

confidence: 99%

The difficult airway with recommendations for management – Part 1 – Difficult tracheal intubation encountered in an unconscious/induced patient

Law

Broemling²,

Cooper³

et al. 2013

Can J Anesth/J Can Anesth

323

260

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BackgroundPreviously active in the mid-1990s, the Canadian Airway Focus Group (CAFG) studied the unanticipated difficult airway and made recommendations on management in a 1998 publication. The CAFG has since reconvened to examine more recent scientific literature on airway management. The Focus Group’s mandate for this article was to arrive at updated practice recommendations for management of the unconscious/induced patient in whom difficult or failed tracheal intubation is encountered. MethodsNineteen clinicians with backgrounds in anesthesia, emergency medicine, and intensive care joined this iteration of the CAFG. Each member was assigned topics and conducted reviews of Medline, EMBASE, and Cochrane databases. Results were presented and discussed during multiple teleconferences and two face-to-face meetings. When appropriate, evidence- or consensus-based recommendations were made together with assigned levels of evidence modelled after previously published criteria.ConclusionsThe clinician must be aware of the potential for harm to the patient that can occur with multiple attempts at tracheal intubation. This likelihood can be minimized by moving early from an unsuccessful primary intubation technique to an alternative “Plan B” technique if oxygenation by face mask or ventilation using a supraglottic device is non-problematic. Irrespective of the technique(s) used, failure to achieve successful tracheal intubation in a maximum of three attempts defines failed tracheal intubation and signals the need to engage an exit strategy. Failure to oxygenate by face mask or supraglottic device ventilation occurring in conjunction with failed tracheal intubation defines a failed oxygenation, “cannot intubate, cannot oxygenate” situation. Cricothyrotomy must then be undertaken without delay, although if not already tried, an expedited and concurrent attempt can be made to place a supraglottic device.

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“…[18] Beside its traditional use to guide endotracheal intubation (ETI), the gum elastic bougie has also been described to facilitate cricothyrotomy in the field. [19] The gum elastic bougie was further evaluated as a guide for intubation after a laryngeal mask airway (LMA) was placed. In a cadaver study, the bougie was placed through an LMA and an endotracheal tube (ETT) was then placed over the bougie.…”

Section: Airway Managementmentioning

confidence: 99%

Advances in prehospital trauma care

Williamson

Ramaiah

Grabinsky

2011

Int J Crit Illn Inj Sci

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Prehospital trauma care developed over the last decades parallel in many countries. Most of the prehospital emergency medical systems relied on input or experiences from military medicine and were often modeled after the existing military procedures. Some systems were initially developed with the trauma patient in mind, while other systems were tailored for medical, especially cardiovascular, emergencies. The key components to successful prehospital trauma care are the well-known ABCs of trauma care: Airway, Breathing, Circulation. Establishing and securing the airway, ventilation, fluid resuscitation, and in addition, the quick transport to the best-suited trauma center represent the pillars of trauma care in the field. While ABC in trauma care has neither been challenged nor changed, new techniques, tools and procedures have been developed to make it easier for the prehospital provider to achieve these goals in the prehospital setting and thus improve the outcome of trauma patients.

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The Bougie-Aided Cricothyrotomy

Cited by 17 publications

References 25 publications

Emergency surgical cricothyroidotomy: 24 successful cases leading to a simple ‘scalpel–finger–tube’ method

Emergency surgical cricothyroidotomy: 24 successful cases leading to a simple ‘scalpel–finger–tube’ method

The difficult airway with recommendations for management – Part 1 – Difficult tracheal intubation encountered in an unconscious/induced patient

Advances in prehospital trauma care

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