Cricothyroidotomy for elective airway management in critically ill trauma patients with technically challenging neck anatomy

Christina G. Rehm, Sandra M. Wanek, Eliot B. Gagnon, Slone K. Pearson, Richard Mullins

    Research output: Contribution to journalArticle

    28 Citations (Scopus)

    Abstract

    Introduction. To assess the value of elective cricothyroidotomy for airway management in critically ill trauma patients with technically challenging neck anatomy. Materials and methods. A retrospective chart review of patients admitted to the Trauma Service at a Level I Trauma Center who underwent cricothyroidotomy for elective airway management over a 40-month period from January 1997 to April 2000. Comparison was made with a cohort of Trauma Service patients who received a tracheostomy. Results. Eighteen patients met study criteria, and an unpaired t test revealed significance (P <0.05) for age only. There was no difference with Injury Severity Score, number of days in the intensive care unit, number of days requiring ventilation post procedure or number of days intubated prior to procedure. The major difference was the more technically challenging neck anatomy in the patients undergoing cricothyroidotomy. Five out of 18 patients undergoing cricothyroidotomy died prior to discharge and two out of 18 died after discharge from complications unrelated to their airway. Two out of 18 patients undergoing tracheostomy died prior to discharge from complications unrelated to their airway. For a period of 1 week-15 months (average, 5.5 months), notes in subsequent clinic appointments were reviewed for subjective assessment of wound healing, breathing and swallowing difficulties, and voice changes. One patient with a cricothyroidotomy required silver nitrate to treat some granulation tissue. Otherwise, no complications were identified. Telephone interviews were conducted with eight of the 11 surviving cricothyroidotomy patients and nine of the 16 surviving tracheostomy patients. One tracheostomy patient required surgical closure 3 months after discharge; otherwise, the only noted change was minor voice changes in three patients in each group. All six of these patients denied that this compromised them in any way. Conclusion. Elective cricothyroidotomy has a low complication rate and is a reasonable, technically less demanding option in critically ill patients with challenging neck anatomy requiring a surgical airway.

    Original languageEnglish (US)
    Pages (from-to)531-535
    Number of pages5
    JournalCritical Care
    Volume6
    Issue number6
    DOIs
    StatePublished - Dec 2002

    Fingerprint

    Airway Management
    Critical Illness
    Anatomy
    Neck
    Wounds and Injuries
    Tracheostomy
    Silver Nitrate
    Injury Severity Score
    Granulation Tissue
    Trauma Centers
    Deglutition
    Wound Healing
    Intensive Care Units
    Ventilation

    ASJC Scopus subject areas

    • Critical Care and Intensive Care Medicine

    Cite this

    Cricothyroidotomy for elective airway management in critically ill trauma patients with technically challenging neck anatomy. / Rehm, Christina G.; Wanek, Sandra M.; Gagnon, Eliot B.; Pearson, Slone K.; Mullins, Richard.

    In: Critical Care, Vol. 6, No. 6, 12.2002, p. 531-535.

    Research output: Contribution to journalArticle

    Rehm, Christina G. ; Wanek, Sandra M. ; Gagnon, Eliot B. ; Pearson, Slone K. ; Mullins, Richard. / Cricothyroidotomy for elective airway management in critically ill trauma patients with technically challenging neck anatomy. In: Critical Care. 2002 ; Vol. 6, No. 6. pp. 531-535.
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    abstract = "Introduction. To assess the value of elective cricothyroidotomy for airway management in critically ill trauma patients with technically challenging neck anatomy. Materials and methods. A retrospective chart review of patients admitted to the Trauma Service at a Level I Trauma Center who underwent cricothyroidotomy for elective airway management over a 40-month period from January 1997 to April 2000. Comparison was made with a cohort of Trauma Service patients who received a tracheostomy. Results. Eighteen patients met study criteria, and an unpaired t test revealed significance (P <0.05) for age only. There was no difference with Injury Severity Score, number of days in the intensive care unit, number of days requiring ventilation post procedure or number of days intubated prior to procedure. The major difference was the more technically challenging neck anatomy in the patients undergoing cricothyroidotomy. Five out of 18 patients undergoing cricothyroidotomy died prior to discharge and two out of 18 died after discharge from complications unrelated to their airway. Two out of 18 patients undergoing tracheostomy died prior to discharge from complications unrelated to their airway. For a period of 1 week-15 months (average, 5.5 months), notes in subsequent clinic appointments were reviewed for subjective assessment of wound healing, breathing and swallowing difficulties, and voice changes. One patient with a cricothyroidotomy required silver nitrate to treat some granulation tissue. Otherwise, no complications were identified. Telephone interviews were conducted with eight of the 11 surviving cricothyroidotomy patients and nine of the 16 surviving tracheostomy patients. One tracheostomy patient required surgical closure 3 months after discharge; otherwise, the only noted change was minor voice changes in three patients in each group. All six of these patients denied that this compromised them in any way. Conclusion. Elective cricothyroidotomy has a low complication rate and is a reasonable, technically less demanding option in critically ill patients with challenging neck anatomy requiring a surgical airway.",
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