Emergency cricothyrotomy – a systematic review

Abstract

BackgroundAn emergency cricothyrotomy is the last-resort in most airway management protocols and is performed when it is not possible to intubate or ventilate a patient. This situation can rapidly prove fatal, making it important to identify the best method to establish a secure airway. We conducted a systematic review to identify whether there exists superiority between available commercial kits versus traditional surgical and needle techniques.MethodsMedline, EMBASE and other databases were searched for pertinent studies. The inclusion criteria included manikin, animal and human studies and there were no restrictions regarding the professional background of the person performing the procedure.ResultsIn total, 1,405 unique references were identified; 108 full text articles were retrieved; and 24 studies were included in the review. Studies comparing kits with one another or with various surgical and needle techniques were identified. The outcome measures included in this systematic review were success rate and time consumption. The investigators performing the studies had chosen unique combinations of starting and stopping points for time measurements, making comparisons between studies difficult and leading to many conflicting results. No single method was shown to be better than the others, but the size of the studies makes it impossible to draw firm conclusions.ConclusionsThe large majority of the studies were too small to demonstrate statistically significant differences, and the limited available evidence was of low or very low quality. That none of the techniques in these studies demonstrated better results than the others does not necessarily indicate that each is equally good, and these conclusions will likely change as new evidence becomes available.

Evaluation of a novel Surgicric® cricothyroidotomy device for emergency tracheal access in a porcine model

“…Several techniques have been described for emergency open surgical cricothyroidotomy: as per Advanced Trauma and Life Support (ATLS); Bair Claw device [20]; rapid four-step technique [21]; bougie-assisted emergency cricothyroidotomy [7] and cricothyroidotomy scissor [22]. No significant difference in success rates was found in a recent systematic review [12]. In this study, we deliberately did not specify any particular technique, leaving the participant to use their preferred technique.…”

“…Several have employed a similar methodology to ours [4,9], and the porcine model has been shown to provide both a realistic anatomical representation of the human airway [10] and a useful training tool for cricothyroidotomy [11]. These studies have revealed conflicting success rates, insertion times and safety profiles, and a recent systematic review discussed how no particular device had any clear advantage over the others [12]. NAP4 gives us some data regarding successful outcomes with patients in real life emergencies.…”

Indications and results of emergency surgical airways performed by a physician-staffed helicopter emergency service

“…Previous results also indicated increased success rates and quicker procedure times with the open surgical technique [16,19]. A review on the topic was not able to demonstrate a significant difference between open surgical and needle-guided methods because of the limited number of patients assessed [6].…”

“…(needle or open) [6]. Dutch ambulance nurses are not legally allowed to use drugs to facilitate intubation.…”

Prise en charge du traumatisé grave en secours en montagne

“…La mise en place d'une canule de Guédel est possible, mais pas obligatoire. Si la subluxation est insuffisante, le médecin peut réaliser en sauvetage une cricothyroïdotomie ou coniotomie [8]. En cas de troubles de ventilation, lorsque celui-ci est en rapport avec un pneumothorax suffocant (silence auscultatoire) dans un contexte de traumatisme thoracique, l'exsufflation est urgente.…”