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Comparative Study
. 2020 Aug 27;20(1):216.
doi: 10.1186/s12871-020-01135-2.

Complications of cricothyroidotomy versus tracheostomy in emergency surgical airway management: a systematic review

Fabricio Batistella Zasso  1 , Kong Eric You-Ten  2 , Michelle Ryu  3 , Khrystyna Losyeva  4 , Jaya Tanwani  5 , Naveed Siddiqui  2
Affiliations
Comparative Study

Complications of cricothyroidotomy versus tracheostomy in emergency surgical airway management: a systematic review

Fabricio Batistella Zasso et al. BMC Anesthesiol. .

Abstract

Background: Airway guidelines recommend an emergency surgical airway as a potential life-saving treatment in a "Can't Intubate, Can't Oxygenate" (CICO) situation. Surgical airways can be achieved either through a cricothyroidotomy or tracheostomy. The current literature has limited data regarding complications of cricothyroidotomy and tracheostomy in an emergency situation. The objective of this systematic review is to analyze complications following cricothyroidotomy and tracheostomy in airway emergencies.

Methods: This synthesis of literature was exempt from ethics approval. Eight databases were searched from inception to October 2018, using a comprehensive search strategy. Studies were included if they were randomized controlled trials or observational studies reporting complications following emergency surgical airway. Complications were classified as minor (evolving to spontaneous remission or not requiring intervention or not persisting chronically), major (requiring intervention or persisting chronically), early (from the start of the procedure up to 7 days) and late (beyond 7 days of the procedure).

Results: We retrieved 2659 references from our search criteria. Following the removal of duplicates, title and abstract review, 33 articles were selected for full-text reading. Twenty-one articles were finally included in the systematic review. We found no differences in minor, major or early complications between the two techniques. However, late complications were significantly more frequent in the tracheostomy group [OR (95% CI) 0.21 (0.20-0.22), p < 0.0001].

Conclusions: Our results demonstrate that cricothyroidotomies performed in emergent situations resulted in fewer late complications than tracheostomies. This finding supports the recommendations from the latest Difficult Airway Society (DAS) guidelines regarding using cricothyroidotomy as the technique of choice for emergency surgical airway. However, emergency cricothyroidotomies should be converted to tracheostomies in a timely fashion as there is insufficient evidence to suggest that emergency cricothyrotomies are long term airways.

Keywords: Complications; Cricothyroidotomy; Emergency surgical airway; Systematic review; Tracheostomy.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow chart of the study. Abbreviations: ICTRP = World Health Organization’s International Clinical Trials Registry Platform, ISRCTNR = International Standard Randomised Controlled Trial Number Registry. To be positioned in the Results section
See this image and copyright information in PMC

References

    1. Joffe AM, Aziz MF, Posner KL, Duggan LV, Mincer SL, Domino KB. Management of difficult tracheal intubation: a closed claims analysis. Anesthesiology. 2019;131:818–829. - PMC - PubMed
    1. Cook TM, Woodall N, Frerk C. Fourth National Audit Project: major complications of airway management in the UK: results of the fourth national audit project of the royal college of anaesthetists and the difficult airway society. Part 1: anaesthesia. Br J Anaesth. 2011;106:617–631. - PubMed
    1. Frerk C, Mitchell VS, McNarry AF, et al. Difficult airway society 2015 guidelines for the management of unanticipated difficult intubation in adults. Br J Anaesth. 2015;115:827–848. - PMC - PubMed
    1. Wong DT, Lai K, Chung FF, Ho RY. Cannot intubate–cannot ventilate and difficult intubation strategies: results of a Canadian national survey. Anesth Analg. 2005;100:1439–1446. - PubMed
    1. Apfelbaum JL, Hagberg CA, Caplan RA, et al. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists task force on management of the difficult airway. Anesthesiology. 2013;118:251–270. - PubMed

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