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Cited by 152Airway Management and Intubation TechniquesTracheal and airway disordersTrauma and Emergency Care Studies

Emergency cricothyrotomy—a systematic review

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Langvad, Sofie, Hyldmo, Per Kristian, Nakstad, Anders Rostrup, Vist, Gunn Elisabeth, Sandberg, Marten·2013·Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
DOI 10.1186/1757-7241-21-43PMC PMC3704966
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Abstract

Background: An emergency cricothyrotomy is the last-resort in most airway management protocols and is performed when it is not possible to intubate or ventilate a patient. This situation can rapidly prove fatal, making it important to identify the best method to establish a secure airway. We conducted a systematic review to identify whether there exists superiority between available commercial kits versus traditional surgical and needle techniques. Methods: Medline, EMBASE and other databases were searched for pertinent studies. The inclusion criteria included manikin, animal and human studies and there were no restrictions regarding the professional background of the person performing the procedure. Results: In total, 1,405 unique references were identified; 108 full text articles were retrieved; and 24 studies were included in the review. Studies comparing kits with one another or with various surgical and needle techniques were identified. The outcome measures included in this systematic review were success rate and time consumption. The investigators performing the studies had chosen unique combinations of starting and stopping points for time measurements, making comparisons between studies difficult and leading to many conflicting results. No single method was shown to be better than the others, but the size of the studies makes it impossible to draw firm conclusions. Conclusions: The large majority of the studies were too small to demonstrate statistically significant differences, and the limited available evidence was of low or very low quality. That none of the techniques in these studies demonstrated better results than the others does not necessarily indicate that each is equally good, and these conclusions will likely change as new evidence becomes available.

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  • Wire-guided approaches are not as easy or successful as once believed.

    “However, recent reviews have shown that complications associated with jet ventilation are unacceptably high and wire-guided approaches are not as easy or successful as once believed.[114][115][116][117]”

    From Airway Management in Trauma (2018) · cites this paper as [117]

    The Discussion reports that surgical techniques were generally faster than Seldinger-based wire-guided kits, which supports the claim that wire-guided approaches may be less easy than assumed. But it also says both approaches had high success rates and found no statistically significant difference between them; it does not support the claim that wire-guided approaches were less successful than once believed. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Complications associated with jet ventilation are unacceptably high.

    “However, recent reviews have shown that complications associated with jet ventilation are unacceptably high and wire-guided approaches are not as easy or successful as once believed.[114][115][116][117]”

    From Airway Management in Trauma (2018) · cites this paper as [117]

    The Methods (Types of interventions; page unavailable) describe how a transtracheal catheter can be used with a jet ventilator, but do not assess complications from jet ventilation. A search for jet-ventilation complications, barotrauma, and adverse events found no passage in our copy calling their rate unacceptably high. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

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Research works printed but not linked: 46

  1. Berlac P Hyldmo PK Kongstad P Kurola J Nakstad AR Sandberg M Pre-hospital airway management: guidelines from a task force from the Scandinavian Society for Anaesthesiology and Intensive Care Medicine Acta Anaesthesiol Scand 2008 52 7 897 907 10.1111/j.1399-6576.2008.01673.x 18702752 · DOI
  2. Henderson JJ Popat MT Latto IP Pearce AC Society DA Difficult Airway Society guidelines for management of the unanticipated difficult intubation Anaesthesia 2004 59 7 675 694 10.1111/j.1365-2044.2004.03831.x 15200543 · DOI
  3. Apfelbaum JL Hagberg CA Caplan RA Blitt CD Connis RT Nickinovich DG Hagberg CA Caplan RA Benumof JL Berry FA Practice guidelines for management of the difficult airway: an updated report by the american society of anesthesiologists task force on management of the difficult airway Anesthesiology 2013 118 2 251 270 10.1097/ALN.0b013e31827773b2 23364566 · DOI
  4. Adams BD Cuniowski PA Muck A De Lorenzo RA Registry of emergency airways arriving at combat hospitals J Trauma 2008 64 6 1548 1554 10.1097/TA.0b013e3181728c41 18545122 · DOI
  5. Germann CA Baumann MR Kendall KM Strout TD McGraw K Performance of endotracheal intubation and rescue techniques by emergency services personnel in an air medical service Prehosp Emerg Care 2009 13 1 44 49 10.1080/10903120802474505 19145523 · DOI
  6. Stephens CT Kahntroff S Dutton RP The success of emergency endotracheal intubation in trauma patients: a 10-year experience at a major adult trauma referral center Anesth Analg 2009 109 3 866 872 10.1213/ane.0b013e3181ad87b0 19690259 · DOI
  7. Sagarin MJ Barton ED Chng Y-M Walls RM National Emergency Airway Registry Investigators Airway management by US and Canadian emergency medicine residents: a multicenter analysis of more than 6,000 endotracheal intubation attempts Ann Emerg Med 2005 46 4 328 336 10.1016/j.annemergmed.2005.01.009 16187466 · DOI
  8. Adnet F Jouriles NJ Le Toumelin P Hennequin B Taillandier C Rayeh F Couvreur J Nougière B Nadiras P Ladka A Survey of out-of-hospital emergency intubations in the French prehospital medical system: a multicenter study Ann Emerg Med 1998 32 4 454 460 10.1016/S0196-0644(98)70175-1 9774930 · DOI
  9. McIntosh SE Swanson ER Barton ED Cricothyrotomy in air medical transport J Trauma 2008 64 6 1543 1547 10.1097/TA.0b013e3181271b60 18545121 · DOI
  10. Bair AE Panacek EA Wisner DH Bales R Sakles JC Cricothyrotomy: a 5-year experience at one institution J Emerg Med 2003 24 2 151 156 10.1016/S0736-4679(02)00715-1 12609644 · DOI
  11. Sakles JC Laurin EG Rantapaa AA Panacek EA Airway management in the emergency department: a one-year study of 610 tracheal intubations Ann Emerg Med 1998 31 3 325 332 10.1016/S0196-0644(98)70342-7 9506489 · DOI
  12. Fortune JB Judkins DG Scanzaroli D McLeod KB Johnson SB Efficacy of prehospital surgical cricothyrotomy in trauma patients J Trauma 1997 42 5 832 836 10.1097/00005373-199705000-00013 9191664 · DOI
  13. Jacobson LE Gomez GA Sobieray RJ Rodman GH Solotkin KC Misinski ME Surgical cricothyroidotomy in trauma patients: analysis of its use by paramedics in the field J Trauma 1996 41 1 15 20 10.1097/00005373-199607000-00004 8676411 · DOI
  14. Nugent WL Rhee KJ Wisner DH Can nurses perform surgical cricothyrotomy with acceptable success and complication rates? Ann Emerg Med 1991 20 4 367 370 10.1016/S0196-0644(05)81656-7 2003663 · DOI
  15. Robinson KJ Katz R Jacobs LM A 12-year experience with prehospital cricothyrotomies Air Med J 2001 20 6 27 30 10.1016/S1067-991X(01)70006-5 11692136 · DOI
  16. Boyle MF Hatton D Sheets C Surgical cricothyrotomy performed by air ambulance flight nurses: a 5-year experience J Emerg Med 1993 11 1 41 45 10.1016/0736-4679(93)90008-U 8445185 · DOI
  17. McGill J Clinton JE Ruiz E Cricothyrotomy in the emergency department Ann Emerg Med 1982 11 7 361 364 10.1016/S0196-0644(82)80362-4 7091796 · DOI
  18. Brown J Thomas F What happens with failed blind nasal tracheal intubations? Air Med J 2001 20 2 13 16 10.1016/S1067-991X(01)70093-4 11250613 · DOI
  19. Cook TM Woodall N Frerk C Fourth National Audit P Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia Br J Anaesth 2011 106 5 617 631 10.1093/bja/aer058 21447488 · DOI · Paper page
  20. Holmes JF Panacek EA Sakles JC Brofeldt BT Comparison of 2 cricothyrotomy techniques: standard method versus rapid 4-step technique Ann Emerg Med 1998 32 4 442 446 10.1016/S0196-0644(98)70173-8 9774928 · DOI
  21. Hill C Reardon R Joing S Falvey D Miner J Cricothyrotomy technique using gum elastic bougie is faster than standard technique: a study of emergency medicine residents and medical students in an animal lab Acad Emerg Med 2010 17 6 666 669 10.1111/j.1553-2712.2010.00753.x 20491685 · DOI
  22. Seldinger SI Catheter replacement of the needle in percutaneous arteriography; a new technique Acta Radiol 1953 39 5 368 376 10.3109/00016925309136722 13057644 · DOI
  23. Bair AE Sakles JC A comparison of a novel cricothyrotomy device with a standard surgical cricothyrotomy technique Acad Emerg Med 1999 6 11 1172 1174 10.1111/j.1553-2712.1999.tb00123.x 10569392 · DOI
  24. Schober P Hegemann M Schwarte L Loer S Noetges P Emergency cricothyrotomy-A comparative study of different techniques in human cadavers Resuscitation 2009 80 2 204 209 10.1016/j.resuscitation.2008.10.023 19058897 · DOI
  25. Hubble MW Wilfong DA Brown LH Hertelendy A Benner RW A meta-analysis of prehospital airway control techniques part II: alternative airway devices and cricothyrotomy success rates Prehosp Emerg Care 2010 14 4 515 530 10.3109/10903127.2010.497903 20809690 · DOI
  26. Helmstaedter V Wetsch WA Bottiger BW Hinkelbein J [Comparison of ready-to-use devices for emergency cricothyrotomy: randomized and controlled feasibility study on a mannequin] Anaesthesist 2012 61 4 310 319 10.1007/s00101-012-2008-2 22526742 · DOI
  27. Givens GC Shelton SL Brown EA Emergency cricothyrotomy in confined space airway emergencies: a comparison Prehospital Disaster Med 2011 26 4 259 261 10.1017/S1049023X11006352 21996279 · DOI
  28. Metterlein T Frommer M Ginzkey C Becher J Schuster F Roewer N Kranke P A randomized trial comparing two cuffed emergency cricothyrotomy devices using a wire-guided and a catheter-over-needle technique J Emerg Med 2011 41 3 326 332 10.1016/j.jemermed.2010.04.008 20605389 · DOI
  29. Murphy C Rooney SJ Maharaj CH Laffey JG Harte BH Comparison of three cuffed emergency percutaneous cricothyroidotomy devices to conventional surgical cricothyroidotomy in a porcine model Br J Anaesth 2011 106 1 57 64 10.1093/bja/aeq294 21037267 · DOI
  30. Salah N Mhuircheartaigh RN Hayes N McCaul C A comparison of four techniques of emergency transcricoid oxygenation in a manikin Anesth Analg 2010 110 4 1083 1085 20142338
  31. Mariappa V Stachowski E Balik M Clark P Nayyar V Cricothyroidotomy: comparison of three different techniques on a porcine airway Anaesth Intensive Care 2009 37 6 961 967 20014603
  32. Benkhadra M Lenfant F Nemetz W Anderhuber F Feigl G Fasel J A comparison of two emergency cricothyroidotomy kits in human cadavers Anesth Analg 2008 106 1 182 185 10.1213/01.ane.0000296457.55791.34 18165576 · DOI
  33. Dimitriadis JC Paoloni R Emergency cricothyroidotomy: a randomised crossover study of four methods Anaesthesia 2008 63 11 1204 1208 10.1111/j.1365-2044.2008.05631.x 19032254 · DOI
  34. Assmann NM Wong DT Morales E A comparison of a new indicator-guided with a conventional wire-guided percutaneous cricothyroidotomy device in mannequins Anesth Analg 2007 105 1 148 154 10.1213/01.ane.0000266439.43797.9e 17578970 · DOI
  35. Sulaiman L Tighe SQM Nelson RA Surgical vs wire-guided cricothyroidotomy: a randomised crossover study of cuffed and uncuffed tracheal tube insertion Anaesthesia 2006 61 6 565 570 10.1111/j.1365-2044.2006.04621.x 16704591 · DOI
  36. Schaumann N Lorenz V Schellongowski P Staudinger T Locker GJ Burgmann H Pikula B Hofbauer R Schuster E Frass M Evaluation of Seldinger technique emergency cricothyroidotomy versus standard surgical cricothyroidotomy in 200 cadavers Anesthesiology 2005 102 1 7 11 10.1097/00000542-200501000-00005 15618780 · DOI
  37. Fikkers BG van Vugt S van der Hoeven JG van den Hoogen FJA Marres HAM Emergency cricothyrotomy: a randomised crossover trial comparing the wire-guided and catheter-over-needle techniques Anaesthesia 2004 59 10 1008 1011 10.1111/j.1365-2044.2004.03794.x 15488061 · DOI
  38. Keane MF Brinsfield KH Dyer KS Roy S White D A laboratory comparison of emergency percutaneous and surgical cricothyrotomy by prehospital personnel Prehosp Emerg Care 2004 8 4 424 426 15626006
  39. Vadodaria BS Gandhi SD McIndoe AK Comparison of four different emergency airway access equipment sets on a human patient simulator Anaesthesia 2004 59 1 73 79 10.1111/j.1365-2044.2004.03456.x 14687103 · DOI
  40. Mutzbauer TS Munz R Helm M Lampl LA Herrmann M [Emergency cricothyrotomy–puncture or anatomical preparation? Peculiarities of two methods for emergency airway access demonstrated in a cadaver model] Anaesthesist 2003 52 4 304 310 10.1007/s00101-003-0476-0 12715132 · DOI
  41. Davis DP Bramwell KJ Hamilton RS Chan TC Vilke GM Safety and efficacy of the rapid rour-step technique for cricothyrotomy using a Bair claw J Emerg Med 2000 19 2 125 129 10.1016/S0736-4679(00)00197-9 10903458 · DOI
  42. Eisenburger P Laczika K List M Wilfing A Losert H Hofbauer R Burgmann H Bankl H Pikula B Benumof JL Comparison of conventional surgical versus Seldinger technique emergency cricothyrotomy performed by inexperienced clinicians Anesthesiology 2000 92 3 687 690 10.1097/00000542-200003000-00012 10719947 · DOI
  43. Chan TC Vilke GM Bramwell KJ Davis DP Hamilton RS Rosen P Comparison of wire-guided cricothyrotomy versus standard surgical cricothyrotomy technique J Emerg Med 1999 17 6 957 962 10.1016/S0736-4679(99)00123-7 10595879 · DOI
  44. Johnson DR Dunlap A McFeeley P Gaffney J Busick B Cricothyrotomy performed by prehospital personnel: a comparison of two techniques in a human cadaver model Am J Emerg Med 1993 11 3 207 209 10.1016/0735-6757(93)90125-U 8489658 · DOI
  45. Helm M Hossfeld B Jost C Lampl L Bockers T Emergency cricothyroidotomy performed by inexperienced clinicians--surgical technique versus indicator-guided puncture technique Emerg Med J 2012 Epub ahead of print PMC3717590 22843552
  46. Paix BR Griggs WM Emergency surgical cricothyroidotomy: 24 successful cases leading to a simple ‘scalpel-finger-tube’ method Emerg Med Australas 2012 24 1 23 30 10.1111/j.1742-6723.2011.01510.x 22313556 · DOI

Cited by

Sorted by citations

Authors
Langvad, S., Hyldmo, P. K., Nakstad, A. R., Vist, G. E., & Sandberg, M.
Affiliations
  • University of Oslo (NO)
  • Stiftelsen Norsk Luftambulanse (NO)
  • Oslo University Hospital (NO)
  • Nasjonalt Kunnskapssenter for Helsetjenesten (NO)
ORCID
Venue
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Publisher
Springer Science and Business Media LLC
Published
2013-05-31
Volume
21
Issue
1
Pages
43-43
ISSN
1757-7241 (ISSN-L)
DOI
10.1186/1757-7241-21-43
PMC
PMC3704966
OpenAlex
W2131294738
Cited by
152
References
2
Citations by year
2026: 8 · 2025: 12 · 2024: 11 · 2023: 15 · 2022: 10 · 2021: 15 · 2020: 16 · 2019: 13 · 2018: 12 · 2017: 11 · 2016: 16 · 2015: 6 · 2014: 3 · 2013: 2
FWCI
1.95
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Scandinavian Journal of Trauma Resuscitation and Emergency Medicine (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Duo Research Archive (University of Oslo) (submittedVersion)
  • NORA - Norwegian Open Research Archives (submittedVersion, cc-by)
Topics
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Airway Management and Intubation Techniques
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Tracheal and airway disorders
  • Health Sciences › Medicine › Emergency Medicine › Trauma and Emergency Care Studies
Keywords
emergency cricothyrotomy, airway management, difficult intubation, procedural success rate, procedure time
MeSH terms
Animals, Cricoid Cartilage, Emergency Medical Services, Humans, Laryngeal Cartilages, Manikins, Treatment Outcome, Airway Management

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