Effect of palpable vs. impalpable cricothyroid membranes in a simulated emergency front-of-neck access scenario.
Pairaudeau CF1, Mendonca C1, Hillermann C1, Qazi I1, Baker PA2, Hodgson RE3, Radhakrishna S1.
Author information
1
Department of Anaesthesia, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.
2
Department of Anesthesiology, University of Auckland, New Zealand.
3
Department of Anesthesiology, Inkosi Albert Luthuli Central Hospital, eThekwini-Durban, South Africa.
Abstract
The Difficult Airway Society 2015 guidelines recommend and describe in detail a surgical cricothyroidotomy technique for the can't intubate, can't oxygenate (CICO) scenario, but this can be technically challenging for anaesthetists with no surgical training. Following a structured training session, 104 anaesthetists took part individually in a simulated can't intubate, can't oxygenate event using simulation and airway models to evaluate how well they could perform these front-of-neck access techniques. Main outcomes measures were: ability to correctly perform the technical steps; procedural time; and success rate. Outcomes were compared between palpable and impalpable cricothyroid membrane scenarios. Anaesthetists' technical abilities were good, as assessed by a video analysis checklist score. Mean (SD) procedural time was 44 (16) s and 65 (17) s for the palpable and impalpable cricothyroid membrane models, respectively (p ≤ 0.001). First-pass tracheal tube placement was obtained in 103 out of the 104 palpable cricothyroidotomies and in 101 out of the 104 impalpable cricothyroidotomies (p = 0.31). We conclude that anaesthetists can be trained to perform surgical front-of-neck access to an acceptable level of competence and speed when assessed using a simulator.

© 2018 The Association of Anaesthetists of Great Britain and Ireland.

KEYWORDS:
difficult airway algorithm; failed intubation: treatment; management of difficult airway: obese patient

Comment in
Decision making in a cannot-intubate, cannot-oxygenate scenario. [Anaesthesia. 2018]
PMID: 29349776 DOI: 10.1111/anae.14218