Cricothyroid membrane puncture guided tracheostomy: a new technique for emergency airway access

Publication date: Available online 9 January 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Youbai Chen, Yan Han, Meredith August, Nalton F. Ferraro, Qixu Zhang, Haizhong Zhang
PurposeTo compare cricothyroid membrane puncture guided tracheostomy (CMPGT) to surgical cricothyroidotomy (SC) and percutaneous tracheostomy with Griggs' guidewire dilating forceps (GWDF) for establishing an emergency airway in a porcine model. The investigators hypothesized that CMPGT was associated with a shorter time to ventilation and more rapid restoration of oxygenation.MethodsThe investigators implemented a small pilot animal study. Eighteen miniature pigs were randomly assigned to undergo CMPGT, SC or GWDF. The predictor variable was the technique utilized. The primary outcome variable was time to ventilation. Other outcome variables were efficiency of oxygenation restoration, procedure duration and procedure-related complications. The data were assessed using one-way ANOVA and Boferroni correction. The SpO2 changes over time were graphed using a time series line plot. P value was set at 0.05.ResultsAirways were successfully established in all eighteen pigs. SC (68±4 s) showed the shortest procedure duration compared to GWDF (95±3 s) and CMPGT (96±4 s); however, the time to ventilation using CMPGT (21±2 s) was significantly shorter than SC (68±4 s) and GWDF (95±3 s) (p<0.01). SpO2 in each group increased post-operatively, reaching 95% at 120 s, 131 s and 144 s in the CMPGT, SC and GWDF groups, respectively. The slopes of the ascending phase of SpO2 curve for each procedure was CMPGT (0.38), SC (0.42), and GWDF (0.53) (p<0.05). Two pigs in each group had minor intraoperative bleeding and one pig in SC group had moderate bleeding.ConclusionThe results of this animal study suggest that CMPGT is a time-efficient and safe technique for emergency airway access which allows for more rapid return of ventilation and obviates the need for conversion to definitive tracheostomy. Further cadaver study is ongoing.



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