title: Effect of surgical cricothyrotomy on the unstable cervical spine in a cadaver model of intubation.
abstract: Cricothyrotomy is indicated for patients who require an immediate airway and in whom orotracheal or nasotracheal intubation is unsuccessful or contraindicated. Cricothyrotomy is considered safe with cervical spine (c-spine) injury; however, the amount of c-spine movement that occurs during the procedure has not been determined. In this experimental study, an established cadaver model of c-spine injury was used to quantify movement during cricothyrotomy. A complete C5--6 transection was performed by using an osteotome on 13 fresh-frozen cadavers. Standard open cricothyrotomy was performed on each cadaver, with c-spine images recorded in real time on fluoroscopy, then transferred to video and Kodachrome still images. Outcome measures included movement across the C5--6 site with regard to angulation expressed in degrees of rotation and linear measures of axial distraction and anterior-posterior (AP) displacement expressed as a proportion of C5 body width. Data were analyzed by using descriptive statistics to determine mean change from baseline in each of three planes of movement. Significance was assumed if 95% confidence intervals did not include zero. A significant amount of movement was observed with regard to AP displacement (6.3% of C5 width) and axial distraction (-4.5% of C5 width, indicating narrowing of the intervertebral space). These correspond to 1--2 mm AP displacement and less than 1 mm axial compression. No significant angular displacement was observed. In conclusion, cricothyrotomy results in a small but significant amount of movement across an unstable c-spine injury in a cadaver model. This degree of movement is less than the threshold for clinical significance.
authors.affiliation: University of California at San Diego School of Medicine, UCSD Medical Center, San Diego, California, USA.
authors.forename: M C
authors.initials: MC
authors.lastname: Gerling
authors.forename: D P
authors.initials: DP
authors.lastname: Davis
authors.forename: R S
authors.initials: RS
authors.lastname: Hamilton
authors.forename: G F
authors.initials: GF
authors.lastname: Morris
authors.forename: G M
authors.initials: GM
authors.lastname: Vilke
authors.forename: S R
authors.initials: SR
authors.lastname: Garfin
authors.forename: S R
authors.initials: SR
authors.lastname: Hayden
mesh_terms: D002102:Cadaver; D002574:Cervical Vertebrae; D003413:Cricoid Cartilage / Q000601:surgery*; D004632:Emergency Medical Services / Q000379:methods*; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D008954:Models, Biological; D013124:Spinal Injuries / Q000473:pathology*; D013957:Thyroid Cartilage / Q000601:surgery*; D014140:Tracheotomy