The role of ultrasound in front-of-neck access for cricothyroid membrane identification: A systematic review

Rai, Yeshith; You-Ten, Eric; Zasso, Fabricio Batistella; Castro, Charmaine De; Ye, Xiang Y.; Siddiqui, Naveed

doi:10.1016/j.jcrc.2020.07.030

Cited by 21 publications

(4 citation statements)

References 35 publications

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“…Ultrasound outperforms visual inspection and digital palpation in the identification of the CTM [124][125][126]. One prior study demonstrated that ultrasound guidance during cricothyrotomy resulted in a five-fold improvement in correct tube placement among subjects with anatomy that was difficult to palpate [127].…”

Section: Preparation For Cricothyrotomymentioning

confidence: 99%

Point-of-Care Ultrasound in Airway Evaluation and Management: A Comprehensive Review

et al. 2023

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Airway management is a common and critical procedure in acute settings, such as the Emergency Department (ED) or Intensive Care Unit (ICU) of hospitals. Many of the traditional physical examination methods have limitations in airway assessment. Point-of-care ultrasound (POCUS) has emerged as a promising tool for airway management due to its familiarity, accessibility, safety, and non-invasive nature. It can assist physicians in identifying relevant anatomy of the upper airway with objective measurements of airway parameters, and it can guide airway interventions with dynamic real-time images. To date, ultrasound has been considered highly accurate for assessment of the difficult airway, confirmation of proper endotracheal intubation, prediction of post-extubation laryngeal edema, and preparation for cricothyrotomy by identifying the cricothyroid membrane. This review aims to provide a comprehensive overview of the key evidence on the use of ultrasound in airway management. Databases including PubMed and Embase were systematically searched. A search strategy using a combination of the term “ultrasound” combined with several search terms, i.e., “probe”, “anatomy”, “difficult airway”, “endotracheal intubation”, “laryngeal edema”, and “cricothyrotomy” was performed. In conclusion, POCUS is a valuable tool with multiple applications ranging from pre- and post-intubation management. Clinicians should consider using POCUS in conjunction with traditional exam techniques to manage the airway more efficiently in the acute setting.

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Section: Preparation For Cricothyrotomymentioning

confidence: 99%

Point-of-Care Ultrasound in Airway Evaluation and Management: A Comprehensive Review

et al. 2023

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“…Fortunately, the CTM will return to the correct location when the patient is returned to the same position as when they were originally marked [99]. Therefore, it is advisable to mark the CTM in neck extension as close to the anticipated procedural position as possible prior to any attempted airway intervention [84,100].…”

Section: Identifying the Cricothyroid Membranementioning

confidence: 99%

Point-of-care ultrasound for airway management in the emergency and critical care setting

Gottlieb,

O’Brien,

Ferrigno

et al. 2023

Clin Exp Emerg Med

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Airway management is a common procedure within emergency and critical care medicine. Traditional techniques for predicting and managing a difficult airway each have important limitations. As the field has evolved, point-of-care ultrasound has been increasingly utilized for this application. Several measures can be used to sonographically predict a difficult airway, including skin to epiglottis, hyomental distance, and tongue thickness. Ultrasound can also be used to confirm endotracheal tube intubation and assess endotracheal tube depth. Ultrasound is superior to the landmark-based approach for locating the cricothyroid membrane, particularly in patients with difficult anatomy. Finally, we provide an algorithm for using ultrasound to manage the crashing patient on mechanical ventilation. After reading this article, readers will have an enhanced understanding of the role of ultrasound in airway management.

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“…Ultrasonography has been widely used in airway management, such as the prediction of difficult airways [ 2 ], the localization of cricothyroid membranes [ 3 , 4 ], the selection of tracheal tubes [ 5 , 6 ], and the evaluation of patients with a full stomach [ 7 ]. Among them, ultrasonic measurements of the dimensions of certain airway parameters have predictive value for difficult airways; therefore, airway ultrasonography has been proposed as an adjunct to difficult airway prediction [ 2 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of ultrasonic measurement for the hyomental distance and distance from skin to epiglottis in predicting difficult laryngoscopy in children

Zheng

Wang

et al. 2023

Eur Radiol

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Objectives Studies have shown that some ultrasonic indicators can predict difficult airways in adults to an extent. However, whether ultrasonic parameters can be used to predict difficult airways in children is unclear. This study investigated the predictive value of several ultrasonic indices for difficult laryngoscopy (DL) in children. Methods Pediatric patients aged 5 to 12 years who underwent endotracheal intubation under general anesthesia were enrolled. The hyomental distance in the extended position (HMDE), tongue thickness, midsagittal tongue cross-sectional area, tongue width, and distance from skin to epiglottis (DSE) were measured by ultrasound before anesthesia. The study end point was DL. The receiver operating characteristic curve was used to evaluate the predictive value of each parameter. Results Three hundred and ten children were included in the final analysis, and fifteen (4.8%) children had DL. The shortened HMDE assessed by ultrasound could help identify children aged 5 to 12 years with DL (5–8 years: area under the curve (AUC) 0.74, sensitivity 0.88, specificity 0.60; 9–12 years: AUC 0.72, sensitivity 0.71, specificity 0.83). An increased DSE could help identify children aged 5 to 8 years with DL (AUC 0.76, sensitivity 0.88, specificity 0.69). Conclusions Ultrasonic measurement of the HMDE can be used to predict DL in children aged 5 to 12 years. The DSE measured by ultrasound can be used to predict DL in children aged 5 to 8 years. Clinical relevance statement The hyomental distance and the distance from skin to epiglottis measured by ultrasound can be used to predict difficult laryngoscopy in children, which can help reduce serious complications caused by unanticipated difficult airways in children during anesthesia. Key Points • Ultrasonic measurement of the hyomental distance in the extended position may be an effective predictor of difficult laryngoscopy in children aged 5 to 12 years. • The distance from skin to epiglottis measured by ultrasound can be used to predict difficult laryngoscopy in children aged 5 to 8 years. • Preoperative airway assessment using ultrasound can be effectively applied in children and has a great application prospect.

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The role of ultrasound in front-of-neck access for cricothyroid membrane identification: A systematic review

Cited by 21 publications

References 35 publications

Point-of-Care Ultrasound in Airway Evaluation and Management: A Comprehensive Review

Point-of-Care Ultrasound in Airway Evaluation and Management: A Comprehensive Review

Point-of-care ultrasound for airway management in the emergency and critical care setting

Effectiveness of ultrasonic measurement for the hyomental distance and distance from skin to epiglottis in predicting difficult laryngoscopy in children

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