The great airway debate: is the scalpel mightier than the cannula?

Baker, Paul; O’Sullivan, E.; Kristensen, Michael Seltz; Lockey, David

doi:10.1093/bja/aew219

Cited by 41 publications

(35 citation statements)

References 20 publications

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“…One of the desirable features for any front-of-neck access technique is its ability to be taught easily [14]. No matter how proficient a technique is in the hands of experts, if it cannot be successfully taught to practicing anaesthetists in a short period of time using simple and inexpensive training tools, it will have limited real-world utility.…”

Section: Discussionmentioning

confidence: 99%

Effect of palpable vs. impalpable cricothyroid membranes in a simulated emergency front‐of‐neck access scenario

et al. 2018

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The Difficult Airway Society 2015 guidelines recommend and describe in detail a surgical cricothyroidotomy technique for the can't intubate, can't oxygenate (CICO) scenario, but this can be technically challenging for anaesthetists with no surgical training. Following a structured training session, 104 anaesthetists took part individually in a simulated can't intubate, can't oxygenate event using simulation and airway models to evaluate how well they could perform these front-of-neck access techniques. Main outcomes measures were: ability to correctly perform the technical steps; procedural time; and success rate. Outcomes were compared between palpable and impalpable cricothyroid membrane scenarios. Anaesthetists' technical abilities were good, as assessed by a video analysis checklist score. Mean (SD) procedural time was 44 (16) s and 65 (17) s for the palpable and impalpable cricothyroid membrane models, respectively (p ≤ 0.001). First-pass tracheal tube placement was obtained in 103 out of the 104 palpable cricothyroidotomies and in 101 out of the 104 impalpable cricothyroidotomies (p = 0.31). We conclude that anaesthetists can be trained to perform surgical front-of-neck access to an acceptable level of competence and speed when assessed using a simulator.

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Section: Discussionmentioning

confidence: 99%

Effect of palpable vs. impalpable cricothyroid membranes in a simulated emergency front‐of‐neck access scenario

et al. 2018

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“…Interestingly, discussion in anesthesiology journals mainly concern small bore (needle) cricothyrotomy versus scalpel (bougie) cricothyrotomy when choosing a FONA technique. 13,14 Our results show a different perspective in ENT surgeons and residents; these different perspectives should at the very least be shared interdisciplinary.…”

Section: Materials and Protocolsmentioning

confidence: 77%

Emergency front‐of‐neck airway by ENT surgeons and residents: A dutch national survey

Bruijstens

Titulaer

Scheffer

et al. 2018

Laryngoscope Investig Oto

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ObjectivesENT surgeons and anesthesiologists work closely together in managing challenging airway cases. Sharing knowledge, experiences, and expectations interdisciplinary is essential in order to facilitate decision‐making and adequate management in emergency front‐of‐neck airway cases.MethodsA survey was performed, to analyze level of experience, technique of preference, training, knowledge of material and protocols, and self‐efficacy scores of Dutch ENT surgeons and residents in performing an urgent or emergency front‐of‐neck airway.ResultsWithin one year (January 2014–2015), 25.7% of the 257 respondents had performed an urgent or emergency front‐of‐neck airway. Of all reported emergency front‐of‐neck airways (N = 30), 80% were managed by tracheotomy. In future emergency front‐of‐neck airway cases, 74% stated cricothyrotomy would be their technique of preference. The majority would choose an uncuffed large‐bore cannula technique. Post‐academic hands‐on training was attended by 42% of respondents. Self‐efficacy scores were highest for surgical tracheotomy, and higher when trained or experienced. In case of an emergency scenario, 8.6% would not perform a front‐of‐neck airway themselves. The main reasons for reluctance to start in general were lack of experience and lack of training. Reported items for improvement were mainly the development of a protocol and training.ConclusionThe chance of encountering an airway emergency scenario requiring front‐of‐neck airway is realistic. There is inconsistency between advised technique, technique of preference and technique actually performed by ENT surgeons. This study shows that there is both a need and desire for improvement in training and organization of care. Interdisciplinary guidelines and education is needed and could eventually safe lives.Level of evidence5

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“…There is a paucity of prospective studies on FONA (3.2%), despite the undoubted importance and recent controversies . Rather than a perceived lack of importance, FONA research is more likely restricted by the limited number of cases, ethical considerations and feasibility in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Airway management research: a systematic review

et al. 2018

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Recent controversy regarding the ethics of conducting airway research in patients led to disagreements concerning the value and frequency of manikin-based investigation. However, no formal examination of the methodology of airway research has been undertaken. We, therefore, performed a systematic bibliometric review of airway management research to describe the conduct, quantify the subjects (patient vs. manikin vs. other), assess the reported outcomes and map global trends. We retrieved 1505 relevant studies published between 2006 and 2017, together recruiting 359,648 subjects, of which 341,233 were patients, the remaining being volunteers or subjects managing manikins, human cadavers, animals or bench models. There were 701 randomised controlled clinical trials (46.6%), 83 non-randomised experimental clinical trials (5.5%), 298 observational studies (19.8%) and 423 non-patient studies (28.1%). A total of 1082 studies (71.9%) were patient studies and 322 were manikin studies (21.4%). The total annual number of airway management studies increased over time, as did the annual number of patient studies, but there was no significant increase in the annual number of manikin studies over time. Of the patient studies, subject baseline characteristics were most likely to be ASA status 1-2 (n = 531, 49.1%), populations were most often elective surgical patients (n = 918, 84.8%) and the most common interventions studied were tracheal intubation (n = 820, 54.4%) or supraglottic airway device insertion (n = 257, 17.1%). There was a total of 77 different primary outcomes used in the included studies, the most commonly reported being success rate and procedure time. By understanding how and what has been previously studied these data can be used to form the basis for future priority setting exercises, core outcome set development, and could inform strategy on the future directions of airway management research.

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The great airway debate: is the scalpel mightier than the cannula?

Cited by 41 publications

References 20 publications

Effect of palpable vs. impalpable cricothyroid membranes in a simulated emergency front‐of‐neck access scenario

Effect of palpable vs. impalpable cricothyroid membranes in a simulated emergency front‐of‐neck access scenario

Emergency front‐of‐neck airway by ENT surgeons and residents: A dutch national survey

Airway management research: a systematic review

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