Front of neck: continued discovery of this anatomy essential for airway management

Kristensen, Michael Seltz; Teoh, Wendy H.

doi:10.1016/j.bja.2018.02.015

Cited by 11 publications

(6 citation statements)

References 25 publications

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“…Of these, the retrograde ''pulling'' technique is especially well-suited in the management of an awake, sitting patient with a profusely bleeding airway. Retrograde intubation, where the tube is pulled either through the nose or mouth into the trachea using an epidural catheter inserted through the CTM, or through the crico-tracheal membrane, 64 has the following advantages: it is relatively simple, requires readily available equipment (an epidural catheter), 47 is independent of vision and thus works in bloody airways, 42 allows intubation via the mouth or the nose as appropriate, 65 and allows re-intubation if necessary (as the catheter is left in situ following extubation). The technique should preferably be used in the awake patient.…”

Section: Profuse Bleedingmentioning

confidence: 99%

Managing and securing the bleeding upper airway: a narrative review

Kristensen

McGuire

2019

Can J Anesth/J Can Anesth

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Section: Profuse Bleedingmentioning

confidence: 99%

Managing and securing the bleeding upper airway: a narrative review

Kristensen

McGuire

2019

Can J Anesth/J Can Anesth

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“…Therefore our results should not be used to estimate DACM in these patients. Although our cases may represent the multi ethnic make‐up of the UK we do not know if our results are valid in certain ethnic groups …”

Section: Discussionmentioning

confidence: 90%

Depth to the airway lumen at the level of the cricothyroid membrane measured by ultrasound

Athanassoglou

Hughes‐Jones

Hadjipavlou

et al. 2019

Acta Anaesthesiol Scand

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Background: Knowing the likely depth to the airway before emergency cricothyroidotomy may improve success in cases where it cannot be measured. Our aim was to measure the depth to the airway at the cricothyroid membrane by ultrasound in a large group of adult patients.Method: Prospective, observational study in two centres, Oxford and Gloucester.Patients presenting for a large variety of surgical operations were studied. Patients under 18 years; pregnant; critically ill; had a history of neck surgery were not included. Ultrasound examination was performed pre-operatively while participants lay supine with their head and neck extended, with light transducer pressure. We measured depth to the airway lumen in mm; age; weight; height and sex. Results:In total 352 patients were studied. We found that depth to the airway lumen strongly correlated with weight (r = 0.855, P < 0.001) and to a lesser extent body mass index (r = 0.781, P < 0.001). Statistical analysis produced an equation to predict upper 95% CI of depth to the airway from the patient's weight: Depth to the airway lumen in mm = (0.13 × weight in kg) + 0.86.Conclusions: If ultrasound measurement is not possible before emergency cricothyroidotomy, the clinician could use our results to predict the depth to the airway by using the patient's weight. If the upper 95% CI were used as the depth of incision, it would enter the airway in 39 out of 40 patients of that weight, without damage to posterior structures in those with a shallower airway. | 49ATHANASSOGLOU eT AL.

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“…7,16 As previously described, success of the procedure depends on accurate midline identification, and any incision can be extended as required. 17 In the anticipated difficult airway scenario, an ultrasound assessment could be performed to identify the midline and location of the CTM before airway management.…”

Section: Discussionmentioning

confidence: 99%

Emergency Front-of-Neck Airway Rescue Via the Cricothyroid Membrane: A High-Resolution Computed Tomography Study of Airway Anatomy in Adults

Fennessy

Greco

Gelber

et al. 2021

Anesthesia &Amp; Analgesia

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BACKGROUND: Emergency front-of-neck airway rescue is recommended in a can’t intubate, can’t oxygenate clinical scenario. Cannula cricothyroidotomy has been reported as having a high failure rate. Our primary aim was to estimate the angle of the trachea in relation to the horizontal axis in a simulated emergency front-of-neck airway rescue position. Our secondary aims were to estimate the optimal cannula angle of approach and evaluate the anatomical relationship of the cricothyroid membrane (CTM) to adjacent structures. We also assessed whether the CTM lies above or below the neck midpoint, a point equidistant from the suprasternal notch (SSN), and the chin surface landmarks. All measurements were compared between the male and female subjects. METHODS: Subjects having elective computed tomography of their thorax were consented to have extension of the computed tomography to include their neck. A preliminary radiation dose and risk assessment deemed the additional radiation to be of very low risk (level IIa). Subjects were positioned supinely on the computed tomography table. Standard neck extension was achieved by placing a pillow under the scapulae and a rolled towel under the neck to simulate emergency front-of-neck airway rescue positioning. RESULTS: Fifty-two subjects were included in this study: 31 men and 21 women. The mean angle of the trachea in relation to the horizontal axis was 25.5° (95% confidence interval [CI], 21.8–29.1) in men and 14.0° (95% CI, 11.5–16.5) in women. The mean minimum angles required for hypothetical cannula cricothyroidotomy for men and women were 55.2° (95% CI, 51.8–58.7) and 50.5° (95% CI, 45.4–55.6), respectively. The CTM was located lower in the neck in men compared to women. The CTM was located below the neck midpoint in 30 of 30 (100%) male subjects and 11 of 20 (55%) female subjects (P < .001). CONCLUSIONS: The trachea angulates posteriorly in a simulated emergency front-of-neck airway rescue position in supine subjects and to a greater degree in men compared to women (P < .001). The minimum angle required for hypothetical cannula cricothyroidotomy was >45° in the majority (75%) of subjects studied. A steeper cannula angle of approach may be more reliable and warrants further clinical study. If airway anatomy is indistinct and performing a vertical scalpel cricothyroidotomy, consideration should be given to performing this incision lower in the neck in men compared to women.

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Front of neck: continued discovery of this anatomy essential for airway management

Cited by 11 publications

References 25 publications

Managing and securing the bleeding upper airway: a narrative review

Managing and securing the bleeding upper airway: a narrative review

Depth to the airway lumen at the level of the cricothyroid membrane measured by ultrasound

Emergency Front-of-Neck Airway Rescue Via the Cricothyroid Membrane: A High-Resolution Computed Tomography Study of Airway Anatomy in Adults

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