Retrograde intubation of the pharynx: An unusual complication of emergency cricothyrotomy

Slobodkin, David; Topliff, Steve; Raife, John

doi:10.1016/s0196-0644(05)80171-4

Cited by 15 publications

(5 citation statements)

References 4 publications

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“…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%

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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: Complicationsmentioning

confidence: 99%

“…When available, a bougie or stylet introducer can also prevent false passage. The rare retrograde cricothyrotomy has only been reported once, 89 but care should be taken to angle the tube inferiorly on insertion.…”

Section: Complicationsmentioning

confidence: 99%

Optimizing Emergent Surgical Cricothyrotomy for use in Austere Environments

Hessert

Bennett

2013

Wilderness & Environmental Medicine

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“…This has included retrograde intubation of the pharynx with a cuffed 7.5 mm endotracheal tube. This was a complicated event in that breath sounds were auscultated; the closed mouth and dependent tongue were sufficient to block exhalation from the tube, forcing some air around it into the lungs (Slobodkin et al, 1992). A 40 per cent complication rate for elective cricothyrotomy (38 cases over three years) was reduced in the following four years to 23 per cent (39 cases).…”

Section: The Value Of Securing An Airway Surgically-and the Problemsmentioning

confidence: 99%

High tracheostomy and other errors – revisited

Bennett¹

1996

J. Laryngol. Otol.

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“…Due to the often critical condition that patients requiring intubation present with, the nature and incidence of potential complications is important to consider. Several studies have reported immediate complications associated with ED intubations 1–4. These studies, with the exception of rare case reports, have focused only on complications apparent during the ED visit.…”

Section: Introductionmentioning

confidence: 99%

Delayed Complications of Airway Management in the Emergency Department

Sakles¹

2002

Academic Emergency Medicine

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ObjectivesAirway management is a critical procedure performed frequently in emergency departments (EDs). Previous studies have evaluated the complications associated with this procedure but have focused only on the immediate complications. The purpose of this study is to determine the incidence and nature of delayed complications of tracheal intubation performed in the ED at an academic center where intubations are performed by emergency physicians (EPs).MethodsAll tracheal intubations performed in the ED over a one-year period were identified; 540 tracheal intubations were performed during the study period. Of these, 523 charts (96.9%) were available for review and were retrospectively examined. Using a structured datasheet, delayed complications occurring within seven days of intubation were abstracted from the medical record. Charts were scrutinized for the following complications: acute myocardial infarction (MI), stroke, airway trauma from the intubation, and new respiratory infections. An additional 30 consecutive intubations were examined for the same complications in a prospective arm over a 29-day period.ResultsThe overall success rate for tracheal intubation in the entire study group was 99.3% (549/553). Three patients who could not be orally intubated underwent emergent cricothyrotomy. Thus, the airway was successfully secured in 99.8% (552/553) of the patients requiring intubation. One patient, a seven-month-old infant, had unanticipated subglottic stenosis and could not be intubated by the emergency medicine attending or the anesthesiology attending. The patient was mask ventilated and was transported to the operating room for an emergent tracheotomy. Thirty-four patients (6.2% [95% CI 4.3 – 8.5%]) developed a new respiratory infection within seven days of intubation. Only 18 patients (3.3% [95% CI 1.9 – 5.1%]) had evidence of a new respiratory infection within 48 hours, indicating possible aspiration pneumonia secondary to airway management. Three patients (0.5% [95% CI 0.1 – 1.6%]) suffered an acute MI, but none appeared to be related to the intubation. One patient was having an acute MI at the time of intubation and the other two patients had MIs more than 24 hours after the intubation. No patient suffered a stroke (0% [95% CI 0 – 0.6%]). No patients suffered any serious airway trauma such as a laryngeal or vocal cord injury.ConclusionsEmergency tracheal intubation in the ED is associated with an extremely high success rate and a very low rate of delayed complications. Complication rates identified in this study compare favorably to reports of emergency intubations in other hospital settings. Tracheal intubation can safely be performed by trained EPs.

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Retrograde intubation of the pharynx: An unusual complication of emergency cricothyrotomy

Cited by 15 publications

References 4 publications

Optimizing Emergent Surgical Cricothyrotomy for use in Austere Environments

Optimizing Emergent Surgical Cricothyrotomy for use in Austere Environments

High tracheostomy and other errors – revisited

Delayed Complications of Airway Management in the Emergency Department

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