Practical Advance in Obtaining an Emergency Airway via Cricothyroidotomy

Huber, W. G.; Dahman, Marc H.; Thomas, D. A. H.; Lipschutz, Joshua H.

doi:10.7205/milmed.172.5.504

Cited by 7 publications

(5 citation statements)

References 3 publications

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“…64 Owens et al 64 66 examined different cricothyrotomy devices in a controlled lung model for compliance and resistance of airway device diameters. They reported that a spike and drip chamber device for an improvised airway, previously documented by Huber, 63 does not provide effective ventilation. The device's inner diameter needs to be at least 4 mm, confirming the results of Owens et al 64 They also found that cuffed cricothyrotomy devices, which prevent air leakage around the tube, are essential for best ventilation.…”

Section: Improvised Cricothyrotomymentioning

confidence: 99%

“…Published cases indicate that many everyday objects can be used for cricothyrotomy. In the words of Dr Nancy Shannon, “a field expedient tube or object may be utilized.” 37 Reported objects include a sport bottle drinking-straw, 61 a modified nasal speculum, 62 a cutoff syringe barrel (3 mL with 7.0 ET tube adapter), intravenous tubing chamber with spike, 63 ET tubes, 32 ,33,37 ballpoint pens, 64 specialized keychains, 65 and others. The Lifestat keychain (French Pocket Airway, Inc, New Orleans, LA) is a specially designed device with built-in trochar, cannula, and adapter pieces for field-expedient cricothyrotomy.…”

Section: Improvised Cricothyrotomymentioning

confidence: 99%

“…Emergency care providers are most concerned with immediate complications because they have to be handled straightaway. Notable immediate complications include misplaced incision (leading complication in military and civilian data) with incorrect placement through the thyrohyoid (thyroid) membrane, 13 ,14,26 iatrogenic injury to the thyroid or cricothyroid cartilage when using a cricothyrotomy hook, aspiration of blood or vomitus, tube occlusion with blood, 61,88 false passage, retrograde intubation, 89 mainstem intubation, 61 excessive edema, hemorrhage or hematoma formation, 63,90 posterior tracheal laceration, inadvertent extubation, and others.…”

Section: Complicationsmentioning

confidence: 99%

“…The intravenous tubing chamber with spike, described above, has been documented in a case series with good results when combined with a jet ventilator. 63 A person can breath spontaneously through a small catheter after percutaneous needle cricothyrotomy. 67,68 Once the major goal of opening the airway is accomplished, many different tools can be used to provide varying degrees of oxygenation and ventilation.…”

Section: Improvised Cricothyrotomymentioning

confidence: 99%

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Optimizing Emergent Surgical Cricothyrotomy for use in Austere Environments

Hessert

Bennett

2013

Wilderness & Environmental Medicine

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Emergent cricothyrotomy is an infrequently performed procedure used in the direst of circumstances on the most severely injured patients. Austere environments present further unique challenges to effective emergency medical practice. Recently, military trauma registry data were searched for the frequency of cricothyrotomy use and success rates during a 22-month period. These data revealed that cricothyrotomy performed in the most rigorous austere environment (ie, battlefield) had many successes, but also a large number of failed (33%) attempts by medics owing to many factors. Thus, the aim of this review article is to present what is known about cricothyrotomy and apply this knowledge to any austere environment for qualified providers. The National Library of Medicine's PubMed was used to conduct a thorough search using the terms "prehospital," "cricothyroidotomy," "cricothyrotomy," and "surgical airway." The findings were further narrowed by applicability to the austere environment. This review presents relevant airway anatomy, incidences, indications, contraindications, procedures, and equipment, including improvised devices, success rates, complications, and training methods. Recommendations are proffered for ways to optimize procedures, equipment, and training for successful application of this emergent skill set in the austere environment.

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Section: Improvised Cricothyrotomymentioning

confidence: 99%

Section: Improvised Cricothyrotomymentioning

confidence: 99%

Section: Complicationsmentioning

confidence: 99%

Section: Improvised Cricothyrotomymentioning

confidence: 99%

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Optimizing Emergent Surgical Cricothyrotomy for use in Austere Environments

Hessert

Bennett

2013

Wilderness & Environmental Medicine

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“…Performing the procedure of needle cricothyroidotomy is simple, and the equipment needed (16 gauge BD Angiocath™ IV Catheter) is readily available in clinical settings [6][7][8]. However, the conventional method is performed blindly, which can make it difficult to confirm needle location in some cases [9]. It is difficult to distinguish the tissue layers that the needle travels through, and it may cause damage to surrounding tissues.…”

Section: Introductionmentioning

confidence: 99%

Dual-wavelength fiber-optic technique to assist needle cricothyroidotomy

et al. 2020

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The traditional needle cricothyroidotomy procedure is performed blindly without any medical equipment. Complications including posterior tracheal wall perforation, accidental vessel puncture, and missed tracheal puncture are reported. Therefore, we proposed a dual-wavelength fiber-optic technique based on the technique of near-infrared spectroscopy to assist operators performing needle cricothyroidotomy in a swine model. We embedded optical fibers in a 16-gauge intravenous needle catheter. Real-time data were displayed on an oscilloscope, and we used the program to analyze the data immediately. The change of optical density corresponding to 690-nm and 850-nm wavelengths and hemoglobin parameters (HbO 2 and Hb concentrations) was analyzed immediately using the program in the laptop. Unique and significant optical differences were presented in this experiment. We could easily identify every different tissue by the change of optical density corresponding to 690-nm and 850-nm wavelengths and hemoglobin parameters (HbO 2 and Hb concentrations). Statistical method (Kruskal-Wallis H test) was used to compare differences in tissues at each time-point, respectively. The p values in every tissue in optical density change corresponding to 690 nm and 850 nm were all < 0.001. Furthermore, the p values in every tissue in Hb and HbO 2 were also all < 0.001. The results were statistically significant. This is the first and novel study to introduce a dual-wavelength embedded fibers into a standard cricothyroidotomy needle. This proposed system might be helpful to provide us real-time information of the advanced needle tip to decrease possible complications.

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