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. 2019 Nov 19;4(6):602-608.
doi: 10.1002/lio2.314. eCollection 2019 Dec.

Best practices for emergency surgical airway: A systematic review

Elliana K DeVore  1 , Andrew Redmann  2   3 , Rebecca Howell  2 , Sid Khosla  2
Affiliations

Best practices for emergency surgical airway: A systematic review

Elliana K DeVore et al. Laryngoscope Investig Otolaryngol. .

Abstract

Objective: In the case of an emergency surgical airway, current guidelines state that surgical cricothyrotomy is preferable to tracheotomy. However, complications associated with emergency cricothyrotomy may be more frequent and severe. We systematically reviewed the English literature on emergency surgical airway to elicit best practices.

Methods: PubMed, Embase, MEDLINE, and the Cochrane Library were searched from inception to January 2019 for studies reporting emergency cricothyrotomy and tracheotomy outcomes. All English-language retrospective analyses, systematic reviews, and meta-analyses were included. Case reports were excluded, as well as studies with pediatric, nonhuman, or nonliving subjects.

Results: We identified 783 articles, and 20 met inclusion criteria. Thirteen evaluated emergency cricothyrotomy and included 1,219 patients (mean age = 39.8 years); 4 evaluated emergency tracheotomy and included 342 patients (mean age = 46.0 years); 2 evaluated both procedures. The rate of complications with both cricothyrotomy and tracheotomy was comparable. The most frequent early complications were failure to obtain an airway (1.6%) and hemorrhage (5.6%) for cricothyrotomy and tracheotomy, respectively. Airway stenosis was the most common long-term complication, occurring at low rates in both procedures (0.22-7.0%).

Conclusions: Complications associated with emergency cricothyrotomy may not occur as frequently as presumed. Tracheotomy is an effective means of securing the airway in an emergent setting, with similar risk for intraoperative and postoperative complications compared to cricothyrotomy. Ultimately, management should depend on clinician experience and patient characteristics.

Level of evidence: IV.

Keywords: Tracheotomy; emergencies; postoperative complications; retrospective studies.

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Figures

Figure 1
Figure 1
Flow diagram of the literature search based on the PRISMA recommendations. PRISMA = preferred reporting items for systematic reviews and meta‐analysis.
Figure 2
Figure 2
Cricothyrotomy attempt in thyrohyoid space. This patient underwent accidental cannulation of the thyrohyoid membrane, rather than cricothyroid membrane, during a cricothyrotomy attempt.
Figure 3
Figure 3
Endoscopic view of the endotracheal tube entering through the thyrohyoid space during a cricothyrotomy attempt.
See this image and copyright information in PMC

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