Surgical airway procedures in emergency surgical patients: Results of what has become a back‐up procedure

Abstract

Background Cricothyroidotomy and surgical tracheostomy are methods to secure airway patency. In emergency surgery, these methods are nowadays mostly reserved for patients unsuited for percutaneous procedures. Detailed description of complications and functional outcomes following both procedures is underreported in current literature. The aim of this study was to evaluate outcomes following cricothyroidotomy and tracheostomy in this presumed complex population. Methods In this retrospective cohort study, adult emergency surgical patients treated with cricothyroidotomy and/or surgical tracheostomy were included. Postoperative complications and functional outcomes in trauma and non-trauma patients were evaluated. Results Forty-one trauma patients and 11 non-trauma emergency surgical patients (mainly after elective onco-abdominal or vascular surgery) were included. Of 52 patients, seven underwent cricothyroidotomy pre-tracheostomy. Mortality was higher in non-trauma patients (p = 0.04) following both procedures. Over half of patients (56%, n = 29) regained unsupported airway patency with a tendency toward increased tracheostomy removal in trauma patients. Among complications, only pneumonia occurred frequently (60%, n = 31), with no relation to patient type. Other complications included local infection (5.8%, n = 4) and wound dehiscence (1.9%, n = 1). Adverse functional outcomes were frequently observed and were mild and self-limiting. Cervical spinal cord injury reduced overall unsupported airway patency (p = 0.01); with high cervical spinal cord injury related to adverse functional outcomes and increased home ventilation need. Conclusions No major procedure-related complications or functional adverse events were encountered following cricothyroidotomy and surgical tracheostomy, even though only complex patients were included. Only mild, self-limiting functional problems occurred, especially in trauma patients with cervical injury who underwent early tracheostomy by longitudinal incision. This information can aid clinicians in making tailor-made decisions for individual patients.

[Retracted] Study on Risk Factors and Nutritional Status of Postoperative Infection in Patients Undergoing Abdominal Surgery

“…Previous studies have shown that patients undergoing abdominal surgery have a high proportion of postoperative infection [ 10 ]. In recent years, with the continuous progress of medical technology, abdominal surgery gradually tends to be minimally invasive, helping many clinical patients to receive relevant diagnosis and treatment as soon as possible [ 11 ].…”

Emergency front-of-neck access in cardiac arrest: A scoping review

“… 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 Of the 69 included studies, there was one randomised controlled trial and 68 observational studies. 10 , 11 , 12 , ...…”

“…Overall, 36 studies (eight (22%) pre-hospital, 13 (36%) in-hospital, nine (25%) combined in-hospital and pre-hospital, six (17%) in the battlefield setting) reported complications with eFONA. 11 , 12 , 20 , 22 , 24 , 27 , 32 , 40 , 41 , 43 , 44 , 53 , 54 , 62 , 63 , 65 , 67 , 70 , 71 , 16 , 17 , 35 , 36 , 37 , 38 , 46 , 47 , 48 , 49 , 50 , 56 , 57 , 58 , 59 Four studies reported immediate complications, including incorrect site of tube placement, procedure time greater than 3 min, and haemorrhage. 32 , 40 , 56 , 63 One study reported a long-term complication: laryngeal fracture with permanent dysphonia.…”

Prevenção De Complicações Pós-Operatórias Em Idosos

“…A cricotireotomia é considerada uma técnica de via aérea definitiva -incisão e colocação de um tubo na traqueia com um balonete posicionado abaixo das cordas vocais (AZAMBUJA et al, 2021; BAIR; CARO, 2019) -é uma alternativa realizada, em ambiente pré e intra hospitalar, por profissionais treinados, nas situações de emergência em que o paciente possui dificuldade respiratória grave, nos procedimentos que o acesso às vias aéreas por meio da intubação endotraqueal são impossibilitadas ou devido a presença de contraindicações e presença de riscos (WILLINGE et al, 2021;AZAMBUJA et al, 2021).…”

“…Segundo os estudos, essa técnica é o cenário final das diretrizes de manejo, referida pelo algoritmo "can't intubate -can't oxygenate" (CICO) ou "não é possível ventilar -não é possível oxigenar" (MELCHIORS et al, 2016;JOHNSTON;DAVIS, 2020;WILLINGE et al, 2021), sendo a cricotireotomia cirúrgica preconizada como uma forma alternativa de dar suporte de modo rápido e estratégico. As indicações para esse procedimento são a obstrução por edema de glote, as hemorragias orofaríngeas graves, o trauma maxilofacial extenso ou cervical, a presença de corpo estranho ao obstruir a via aérea e a anatomia do paciente ser considerada difícil para realização da intubação (BAIR; CARO, 2019;AZAMBUJA et al, 2021).…”