Can thickness of subcutaneous fat tissue limit emergency percutaneous cricothyrotomy?
Abstract
Introduction: Needle cricothyrotomy is a method of maintaining airways in emergency situations. One
of the identified factors that can make this procedure difficult to perform is ‘a difficult neck anatomy’ or
a short obese neck. Due to the growing problem of obesity, we decided to estimate the feasibility of a needle
cricothyrotomy by measuring the thickness of neck fat tissue in the population. Evaluation of this method is
important because it is the only method that can be legally performed by paramedics in Poland. The aim of
the study was to estimate the feasibility of needle cricoidectomy by evaluating the percentage of population
in which the thickness of subcutaneous fat tissue could potentially limit or complicate such a procedure.
Material and methods: In this retrospective study we reviewed computed tomography (CT) scans of the
neck from the database at the Department of Radiology, University Hospital in Cracow. 550 CT scans met
inclusion criteria: age of patient over 18 years old, lack of any lesions altering the anatomy of measured
region of neck, the first CT scan of patient. 50.36% of patients were women. The median age was 61 years
(range 18–93). The distance from the skin surface at the level of the lower edge of the thyroid cartilage
to the cricothyroid ligament (surface — ligament distance, SLD) was measured. Statistical analysis of the
data was performed using R software (R version 4.0.3).
Results: Median SLD was 1.41 (1.01–2.04). Subcutaneous fat tissue was thicker than maximal depth of
application of cricothyrotomy (3 cm) device in 31 patients (5.64%).
Conclusions: Performing needle cricothyrotomy may be limited to a considerable percentage of the
population (5.64%).
Keywords: Cricothyrotomydifficult neck anatomyemergency airway managementneedle cricothyrotomyobesity
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