The height of the cricothyroid membrane on computed tomography scans in trauma patients

Nutbeam, Tim; Clarke, Ruth; Luff, Tessa; Enki, Doyo Gragn; Gay, David

doi:10.1111/anae.13905

Cited by 19 publications

(30 citation statements)

References 7 publications

(10 reference statements)

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“…Novel tools are enhancing our understanding of airway anatomy , and this study is a contribution to the increasing body of evidence that challenges current widely held views on airway management. If cricoid pressure is deemed to be beneficial, the cricoid cartilage should be located using the best available techniques, and without compromising patient safety.…”

Section: Discussionmentioning

confidence: 99%

A multicentre prospective cohort study of the accuracy of conventional landmark technique for cricoid localisation using ultrasound scanning

et al. 2018

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Cricoid pressure is employed during rapid sequence induction to reduce the risk of pulmonary aspiration. Correct application of cricoid pressure depends on knowledge of neck anatomy and precise identification of surface landmarks. Inaccurate localisation of the cricoid cartilage during rapid sequence induction risks incomplete oesophageal occlusion, with potential for pulmonary aspiration of gastric contents. It may also compromise the laryngeal view for the anaesthetist. Accurate localisation of the cricoid cartilage therefore has relevance for the safe conduct of rapid sequence induction. We conducted a multicentre, prospective cohort study to determine the accuracy of cricoid cartilage identification in 100 patients. The cranio-caudal midpoint of the cricoid cartilage was identified by a qualified anaesthetic assistant using the conventional landmark technique and marked. While maintaining the patient in the same position, a second mark was made by identifying the midpoint of the cricoid cartilage using ultrasound scanning. The mean (SD) distance between the two marks was 2.07 (8.49) mm. In 41% of patients the midpoint was incorrectly identified by a margin greater than 5 mm. This error was uniformly distributed both above and below the midpoint of the cricoid cartilage. The Pearson correlation coefficient of this error with respect to body mass index was 0.062 (p = 0.539) and with age was -0.020 (p = 0.843). There were also no significant differences in error between male and female patients. Identification of cricoid position using a landmark technique has a high degree of variability and has little correlation with age, sex or body mass index. These findings have significant implications for the safe application of cricoid pressure in the context of rapid sequence induction.

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Section: Discussionmentioning

confidence: 99%

A multicentre prospective cohort study of the accuracy of conventional landmark technique for cricoid localisation using ultrasound scanning

et al. 2018

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“…A second issue was raised in a study which suggested that a 6.0-mm tracheal tube may be too big to fit through the CTM [5]. Although this study provided the largest series of measurements to date, the height of the CTM was measured from scans of patients with the head and neck in a neutral position.…”

Section: Introductionmentioning

confidence: 99%

Impact of change in head and neck position on ultrasound localisation of the cricothyroid membrane: an observational study

et al. 2018

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The ideal position for performing surgical cricothyroidotomy is with full neck extension. Some authors have recommended marking the cricothyroid membrane before general anaesthesia, typically with the patient's head and neck in a neutral position. The primary aim of this observational study was to determine whether skin marks made over the centre of the cricothyroid membrane with the head and neck in the neutral position moved outside the boundaries of the membrane when the neck was subsequently extended. The secondary aim was to assess changes in the height of the cricothyroid membrane between the neutral and extended positions. Twenty-two volunteers completed the study. With the head and neck in the neutral position, the distance between the upper and lower borders ('height') of the cricothyroid membrane was measured by a radiologist using ultrasound. The skin was marked over the mid-point of the membrane. The subject then maximally extended the neck, and the measurements and marking were repeated. The skin marking over the centre point of the cricothyroid membrane moved by median (IQR [range]) 5 (4-6 [0-10]) mm when the head and neck were moved from a neutral to a fully extended position. The initial skin mark moved to lie outside the boundary of the cricothyroid membrane in 12 of 22 subjects after extending the neck. The height of the cricothyroid membrane increased by 30% with the neck extended. We recommend that marking the skin in preparation for cricothyroidotomy should be performed with the neck extended, not with the head and neck in the neutral position as previously suggested.

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“…CT is expected to be more precise than the US and palpation method, because CT imaging is considered to be an omnipresent feature reflecting the precise anatomy of CTM. [10] Therefore, this study compares and validates the palpation and US method against the commonly used technique, i.e., CT scan, for the first time to the best of our knowledge.…”

Section: Discussionmentioning

confidence: 93%

“…[7] However, the clinical efficacy of the US guidance to identify the CTM is unclear compared to computed tomography (CT), which is a commonly used radiological technique and allows an accurate identification of the airway structures. [10] The aim of this prospective clinical study was to investigate the success rates of US and conventional finger palpation methods in identifying the cricothyroid membrane (CTM) and comparing the precision of identifying the CTM against the commonly used radiological technique-the CT scan. The time taken to assess CTM using the US and finger palpation methods and the difficulty of using these methods and factors associated with the success rates while determining the CTM localization were the secondary outcomes.…”

Section: Introductionmentioning

confidence: 99%

The role of ultrasonography in the determination of cricothyroid membrane localization in the predicted difficult airway

Altun

Ali

Koltka

et al. 2019

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: The aim of this study was to investigate the success rates of ultrasound (US) and palpation methods in identifying the cricothyroid membrane (CTM), and compare the results with the gold standard method-computed tomography (CT) scan. METHODS: A total of 110 patients were included into the study. The midline was estimated by a single investigator using both the US and palpation methods from the prominence of the thyroid cartilage to the center of the sternal notch, and the distance was measured (in millimeters) between the two points: Point A (the midpoint of CTM) and Point B (the inferior process of thyroid cartilage). Furthermore, the distance between Point A and Point B was calculated using the CT images. Time taken to assess the CTM by using US and palpation methods were recorded. Moreover, difficulty in using the two methods was measured with the visual analog scale (VAS). In addition, demographic and morphometric characteristics of the patients were noted. RESULTS: The CTM was detected accurately in 50 (45.5%) patients with palpation and 82 (74.5%) with US. In the Bland-Altman analysis, a better agreement was observed with US. The time to assess CTM was shorter with US than with palpation, p<0.001. The VAS scores for the palpation and US difficulty were 5.13±1.1 and 3.32±0.9 (p<0.001), respectively. While an increased neck circumference and thyromental distance were found to be independent risk factors for the success rates of determining the CTM by palpation, body mass index is an independent risk factor for US. CONCLUSION: Localization of the CTM is more accurate and easier with US than palpation. Furthermore, the results gathered with US are in a closer range to CT scan.

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The height of the cricothyroid membrane on computed tomography scans in trauma patients

Cited by 19 publications

References 7 publications

A multicentre prospective cohort study of the accuracy of conventional landmark technique for cricoid localisation using ultrasound scanning

A multicentre prospective cohort study of the accuracy of conventional landmark technique for cricoid localisation using ultrasound scanning

Impact of change in head and neck position on ultrasound localisation of the cricothyroid membrane: an observational study

The role of ultrasonography in the determination of cricothyroid membrane localization in the predicted difficult airway

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