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Background: Emergency Front of Neck access eFONA) via cricothyroidotomy using a size 6 internal diameter tracheal tube is recommended by the Difficult Airway Society in the event of a 'can't intubate, can't oxygenate' (CICO) scenario in adults. There is a lack of clear guidance on whether to retain or remove a previously inserted supraglottic airway device (SAD) before eFONA. We aimed to study the effect of both neck extension and insertion of an SAD on sagittal cricothyroid membrane (CTM) height.
View Article and Find Full Text PDFUnmasking Subglottic Stenosis in an Asthmatic Emergency Needing Front-of-Neck Access: A Case Report.
Cureus
November 2024
Pain Management, Singapore General Hospital, Singapore, SGP.
Subglottic stenosis poses a rare but life-threatening risk for difficult tracheal intubation. Here, we report a unique case of undiagnosed subglottic stenosis discovered during emergency intubation of an 80-year-old woman with type 2 respiratory failure from infective exacerbation of asthma. A small calibre size 5.
View Article and Find Full Text PDFA simulated 'can't intubate, can't oxygenate' manikin crossover study investigating a modified front-of-neck access airway device.
Anaesth Intensive Care
December 2024
Department of Anaesthesia, Royal Hobart Hospital, Hobart, Australia.
A 'can't intubate, can't oxygenate' (CICO) situation is an uncommon and time-critical emergency. Many institutions have adopted a 'scalpel-bougie-endotracheal tube (ETT)' technique based on evidence produced by the 4th National Audit Project of the Royal College of Anaesthetists and 2015 Difficult Airway Society guidelines. We made a modification to the traditional 'scalpel-bougie-ETT' technique, using a shortened bougie and replacing the ETT with a cuffed Melker airway in a preassembled device (called 'Secure Airway for Front-of-neck Emergencies' (SAFE airway device)), which we felt might reduce cognitive load on a single operator in an emergency CICO situation.
View Article and Find Full Text PDFA high-fidelity non-animal model for simulation of infant emergency front-of-neck access.
Br J Anaesth
December 2024
Ara Manawa (Design & Innovation Studio), Te Whatu Ora (Health New Zealand), Auckland, New Zealand.
Cricothyroidotomy in out-of-hospital cardiac arrest: An observational study.
Resusc Plus
December 2024
Ambulance Victoria, 375 Manningham Rd, Doncaster, Melbourne, Victoria 3108, Australia.
Aim: To describe the incidence, characteristics, success rates, and outcomes of out-of-hospital cardiac arrest (OHCA) patients receiving cricothyroidotomy.
Methods: Over an 18-year period, we retrospectively analysed patient care records and cardiac arrest registry data for cricothyroidotomy cases. Multivariable logistic regression analysis was used to examine associations between study characteristics and cricothyroidotomy success.
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