Can thickness of subcutaneous fat tissue limit emergency percutaneous cricothyrotomy?

Abstract

Background Needle cricothyrotomy is a method of maintaining airways in emergency situations. One of identified factors that can make this procedure difficult to perform is ‘difficult neck anatomy’ or short obese neck. Due to the growing problem of obesity, we decided to estimate feasibility of needle cricothyrotomy by measuring the thickness of neck fat tissue in the population. Evaluation of this method is important because it is the only method that can be legally performed by paramedics in Poland. The aim of the study was to estimate feasibility of needle cricoidectomy by evaluating the percentage of population in which the thickness of subcutaneous fat tissue could potentially limit or complicate such a procedure. Methods In this retrospective study we reviewed CT scans of the neck from a database at the Department of Radiology, University Hospital in Cracow. 550 CT scans met inclusion criteria: age of patient over 18 years old, lack of any lesions altering anatomy of measured region of neck, the first CT scan of patient. 50.36% of patients were women. Median age was 61 years (range 18 – 93). The distance from the skin surface at the level of the lower edge of the thyroid cartilage to the cricothyroid ligament (surface - ligament distance, SLD) was measured. Statistical analysis of the data was performed using R software (R version 4.0.3). Results Median SLD was 1.41 (1.01 - 2.04). Subcutaneous fat tissue was thicker than maximal depth of application of cricothyrotomy (3cm) device in 31 patients (5.64%). Conclusions Performing needle cricothyrotomy may be limited in a considerable percentage of population (5.64%).