Emergency cricothyroidotomy: an observational study to estimate optimal incision position and length.
Adolescent
Adult
Aged
Airway Management
Cricoid Cartilage
/ diagnostic imaging
Emergency Medical Services
/ methods
Female
Guidelines as Topic
Humans
Male
Middle Aged
Neck
/ diagnostic imaging
Palpation
Prospective Studies
Sex Characteristics
Thyroid Cartilage
/ diagnostic imaging
Thyroidectomy
/ methods
Ultrasonography
Young Adult
airway management
cricothyroid membrane
cricothyroidotomy
emergency airway management
front of neck access
ultrasonography
Journal
British journal of anaesthesia
ISSN: 1471-6771
Titre abrégé: Br J Anaesth
Pays: England
ID NLM: 0372541
Informations de publication
Date de publication:
Feb 2019
Feb 2019
Historique:
received:
12
05
2018
revised:
18
09
2018
accepted:
02
10
2018
entrez:
29
1
2019
pubmed:
29
1
2019
medline:
4
4
2019
Statut:
ppublish
Résumé
A vertical incision is recommended for cricothyroidotomy when the anatomy is impalpable, but no evidence-based guideline exists regarding optimum site or length. The Difficult Airway Society guidelines, which are based on expert opinion, recommend an 80-100 mm vertical caudad to cephalad incision in the extended neck position. However, the guidelines do not advise the incision commencement point. We sought to determine the minimum incision length and commencement point above the suprasternal notch required to ensure that the cricothyroid membrane would be accessible within its margins. We measured using ultrasound, in 80 subjects (40 males and 40 females) without airway pathology, the distance between the suprasternal notch and the cricothyroid membrane, in the neutral and extended neck positions. We assessed the inclusion of the cricothyroid membrane within theoretical incisions of 0-100 mm in length made at 10 mm intervals above the suprasternal notch. In the 80 subjects, the distance ranged from 27 to 105 mm. Movement of the cricothyroid membrane on transition from the neutral to extended neck position varied from 15 mm caudad to 27 mm cephalad. The minimum incision required in the extended position was 70 mm in males and 80 mm in females, commencing 30 mm above the suprasternal notch. An 80 mm incision commencing 30 mm above the suprasternal notch would include all cricothyroid membrane locations in the extended position in patients without airway pathology, which is in keeping with the Difficult Airway Society guidelines recommended incision length.
Sections du résumé
BACKGROUND
BACKGROUND
A vertical incision is recommended for cricothyroidotomy when the anatomy is impalpable, but no evidence-based guideline exists regarding optimum site or length. The Difficult Airway Society guidelines, which are based on expert opinion, recommend an 80-100 mm vertical caudad to cephalad incision in the extended neck position. However, the guidelines do not advise the incision commencement point. We sought to determine the minimum incision length and commencement point above the suprasternal notch required to ensure that the cricothyroid membrane would be accessible within its margins.
METHODS
METHODS
We measured using ultrasound, in 80 subjects (40 males and 40 females) without airway pathology, the distance between the suprasternal notch and the cricothyroid membrane, in the neutral and extended neck positions. We assessed the inclusion of the cricothyroid membrane within theoretical incisions of 0-100 mm in length made at 10 mm intervals above the suprasternal notch.
RESULTS
RESULTS
In the 80 subjects, the distance ranged from 27 to 105 mm. Movement of the cricothyroid membrane on transition from the neutral to extended neck position varied from 15 mm caudad to 27 mm cephalad. The minimum incision required in the extended position was 70 mm in males and 80 mm in females, commencing 30 mm above the suprasternal notch.
CONCLUSIONS
CONCLUSIONS
An 80 mm incision commencing 30 mm above the suprasternal notch would include all cricothyroid membrane locations in the extended position in patients without airway pathology, which is in keeping with the Difficult Airway Society guidelines recommended incision length.
Identifiants
pubmed: 30686312
pii: S0007-0912(18)30783-9
doi: 10.1016/j.bja.2018.10.003
pii:
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
263-268Informations de copyright
Copyright © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.