Prehospital Emergency Cricothyrotomy in Dogs Part 1: Experiences With Commercial Cricothyrotomy Kits

Abstract

The surgical cricothyrotomy (CTT) has been recommended for emergency front of neck airway access (eFONA) during a cannot intubate, cannot oxygenate scenario for military working dogs (MWD) and civilian law enforcement working dogs (operational K9s). In prehospital and austere environments, combat medics and emergency medical service providers are expected to administer emergency medical care to working dogs and may only have emergency airway kits designed for humans at their disposal. The objective of this article is to provide a detailed description of the application of such devices in cadaver dogs and highlight potential alterations to manufacturer guidelines required for successful tube placement. The kits evaluated included the Portex® PCK, Melker universal cricothyrotomy kit and H&H® emergency cricothyrotomy kit. A novel technique for awake cricothyrotomy in the dog is also described, which can also be considered for in-hospital use, together with the open surgical method described for the H&H® kit. To the authors' knowledge, this is the first publication documenting and providing instruction on the application of commercial cricothyrotomy kits in dogs.

Keywords: CICO; cricothyrotomy; difficult airway; intubation; melker; military working dogs; operational K9; portex.

Figure 1

Portex® PCK. (A) Package when removed from the box. (B) Contents of inner container.

Figure 2

Melker universal cricothyrotomy kit.

Figure 3

H&H emergency cricothyrotomy kit and its contents. (A) Original package. (B) Contents of H&H kit after outer package is removed. (C) Instruments included in the H&H Kit.

Figure 4

Demonstration of how to perform a skin incision without clipping the fur. (A) Part the fur over the intended incision site. (B) Appy tension while the incision is made. (C) Dissection continues through the skin incision.

Figure 5

Steps for insertion of the Portex® cricothyrotomy tube (A-J).

Figure 6

Steps for insertion of the Melker cricothyrotomy tube using the Seldinger technique (A–I).

Figure 7

Steps for insertion of the H&H cricothyrotomy tube using the open surgical technique (A–H).

Figure 8

Steps for the emergency awake cricothyrotomy (A–G). The scalpel-finger-tube technique is demonstrated in (H,I).

Figure 9

Image of unsuccessful dilation over the guidewire (A), requiring a stab incision in to the CTM with the guidewire in situ (B). Subsequent procedures with the Melker kit implementing an incision in to the CTM before placing the guidewire were successful without complications.