A new strategy for difficult airway management with visual needle cricothyroidotomy: a manikin study

• Published in: The American journal of emergency medicine 2014-11, Vol.32 (11), p.1391-1394
• Main Authors: Feng, Yanmei, Ph.D., M.D, Deng, Huisheng, Ph.D., M.D, Liu, Xun, M.M, Xu, Gang, M.M, Huang, Ziyang, M.M, Yan, Bingbing, M.M, Liu, Yijun, M.M, Lv, Jingjing, M.M, Zhang, Yong, Ph.D, Guo, Rui, Ph.D., M.D
• Format: Article
• Language: English
• Subjects: Airway management; Airway Management - methods; Airway systems; Clinical Competence; Cricoid Cartilage - surgery; Efficiency; Emergency; Emergency medical care; Feasibility Studies; Humans; Larynx; Manikins; Medical equipment; Needles; Punctures; Studies; Ventilation; Video-Assisted Surgery - methods
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2014.08.024

Abstract Background Conventional needle cricothyroidotomy uses blind manipulation. We investigated the feasibility and efficiency of a new visually guided needle cricothyroidotomy technique. Methods A 0.9-mm microimaging fiber was delivered into a 14G needle to develop a visual puncture system. 10 inexperienced physicians were randomly assigned to perform 10 repeated needle cricothyroidotomy in each group with both conventional method and visual puncture in a manikin. Tracheal lumen puncture time and number of procedure-related complications were recorded. Results Under visual guidance, the needle successfully reached the tracheal lumen. The anatomy of the upper and lower airways was acquired by further advancing the microimaging fiber into the tracheal lumen of the visual group. The tracheal lumen puncture time was significantly less in the visual group than in the conventional group (3.85 ± 1.54 vs. 9.84 ± 1.08 seconds, P < .001). Damage to the posterior tracheal wall was not observed in the visual group; however, 21% of manikins in the conventional group had procedure-related complications. Conclusions Our results demonstrate that visual needle cricothyroidotomy is feasible, and may lead to a decrease in procedure time and procedure-related complications compared to the conventional procedure. In addition, this strategy may also provide useful information for diagnostic purposes; therefore, visual needle cricothyroidotomy may be a new strategy for the management of difficult airways in future care.