Needle vs surgical cricothyroidotomy: a short cut to effective ventilation.
Cricothyroidotomy can be performed using three techniques. This literature review seeks to determine which is more appropriate for use in prehospital can't intubate/can't ventilate scenarios where laryngeal mask airways prove ineffective. The common approach of inserting a 14-gauge cannula and using low-pressure ventilation via intermittent occlusion of an opening in oxygen tubing (15 l x min(-1) flow) results in ineffective ventilation within 60 s or less, depending on the degree of airway obstruction. In the absence of a high degree of upper airway obstruction, ventilation can be effective if the cannula is attached to a high pressure (45 psi) jet ventilator, but such devices are rare in UK prehospital practice. A self-inflating bag used with a cuffed tube inserted through a horizontal scalpel incision provides sustained adequate ventilation, has a relatively low complication rate compared to needle cricothyroidotomy and is a skill that can be easily taught to paramedics, nurses and doctors.
Scrase
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Department of Academic Emergency Medicine, Academic Centre, The James Cook University Hospital, Middlesbrough, UK.
Woollard
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D000402:Airway Obstruction / Q000601:surgery*; D000818:Animals; D004630:Emergencies; D004632:Emergency Medical Services / Q000379:methods*; D006801:Humans; D007817:Laryngeal Cartilages / Q000601:surgery*; D009339:Needles; D012121:Respiration, Artificial / Q000379:methods*; D014139:Tracheostomy / Q000379:methods*