The Lost Airway

Potnuru, Paul; Artime, Carlos A.; Hagberg, Carin A.

doi:10.1016/j.anclin.2020.08.012

Cited by 8 publications

(4 citation statements)

References 48 publications

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“…Nevertheless, as reported by an audit among the members of the Royal College of Anaesthetists and DAS societies in 2011, OST resulted to be the most successful rescue technique in a series of major airway-related perioperative complications; conversely, over 75% of cases managed with needle CT required a subsequent scalpel-based recovery approach because of initial failure [19]. This tendency was further confirmed by a recent systematic review by DeVore et al [39].…”

Section: Esa: Should Emergency Tracheotomy Be Preferred Over Cricothymentioning

confidence: 90%

“…In the emergency setting, the inability to ensure a proper ETI for patient ventilation and oxygenation -the so-called 'Cannot-Intubate-Cannot-Oxygenate' (CICO) scenario -is one of the factors most affecting short-term prognosis [19]. Although performed by experienced operators, the rate of failed intubations in trauma patients is not negligible.…”

Section: The Emergency Surgical Airway (Esa)mentioning

confidence: 99%

“…In the study by Ono et al, over 23% of 537 patients had at least one complication related to ETI, and 5% of them underwent a rescue emergency surgical airway (ESA) procedure due to intractable ETI failure [20]. Furthermore, it has been reported that ETI failure occurs during elective procedures in about 1 over 50,000 cases, with very high related mortality, up to 25% overall [19]. In the meta-analysis by Cabrini et al, despite preoperatively predicted difficult airway, failed ETI was reported in about 0.6% of patients who underwent an awake intubation attempt by fiberoptic guidance [21].…”

Section: The Emergency Surgical Airway (Esa)mentioning

confidence: 99%

“…SARS-CoV-2 was proved to be responsible for the development of a large clinical spectrum of diseases, collectively called Coronavirus Disease 2019 (COVID- 19), ranging from asymptomatic or subtle symptomatic infections to severe acute distress respiratory syndrome (ARDS). Being the replication of the virus mainly located in the nasopharyngeal tract cells, the respiratory droplets and aerosols from carriers swiftly caused the transmission of the infection worldwide [2].…”

Section: Introduction 11 Covid-19 Pandemic and Sars-cov-2-related Ardsmentioning

confidence: 99%

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Emergency surgical tracheotomy in the era of COVID-19 pandemic

Muriana¹,

Ciriaco²,

Carretta³

et al. 2021

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At the beginning of 2020 a novel variant of coronavirus, named SARS-CoV-2, was identified as responsible for the development of severe pneumonia and acute respiratory distress syndrome (ARDS) with very high mortality, exceeding 30%. The disease caused by SARS-CoV-2, called Coronavirus Disease 2019 (COVID-19), was declared a pandemic by WHO on March 11th, 2020. Patients affected by COVID-19 may present with subtle, specific symptoms, but the sudden onset of life-threatening acute respiratory failure is not uncommon. The peculiarities of the disease combined with the single patient’s comorbidities, e.g. advanced age and cardiovascular diseases, plus hypoxia and hypotension secondary to ARDS, and multiorgan failure, may lead to unexpected difficulties in the case of tracheal intubation. The occurrence of the ‘Cannot-Intubate-Cannot-Oxygenate’ (CICO) scenario in COVID-19 patients represents a hazard not only for the patients but also for the assisting healthcare workers due to the high risk of aerosol-generating infected particles during conventional rescue airway procedures. While international consensus guidelines on the management of CICO scenario in COVID-19 patients are still lacking, there is evidence that both scalpel cricothyrotomy (CT) and open surgical tracheotomy (OST) represent valid alternatives for the establishment of a front-of-neck emergency airway. Primary CT requires a staged conversion to formal tracheotomy; conversely, OST represents a definitive mastery of the airway in COVID-19 patients in case of prolonged mechanical ventilation dependency, avoiding a second procedure and further exposure to aerosols. Furthermore, in patients with facial trauma and/or head and neck tumors, OST allows obtaining safe airway control. In the context of the current pandemic, emergency OST procedure in SARS-CoV-2 positives (or with unknown status) requires adequate arrangements and the use of proper personal protective equipment to limit risks for clinicians.

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Section: Esa: Should Emergency Tracheotomy Be Preferred Over Cricothymentioning

confidence: 90%

Section: The Emergency Surgical Airway (Esa)mentioning

confidence: 99%