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Can thickness of subcutaneous fat tissue limit emergency percutaneous cricothyrotomy?
Affiliations- Center for Innovative Medical Education, Jagiellonian University Medical College, Cracow, Poland, Poland
- Student’s Scientific Group at the Chair of Radiology, Jagiellonian University Medical College, Cracow, Poland
- The University Hospital in Cracow, Poland
- Student’s Scientific Group at the Chair of Radiology, Jagiellonian University Medical College, Cracow, Poland
open access
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%).
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
Cricothyrotomy, difficult neck anatomy, emergency airway management, needle cricothyrotomy, obesity
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About this articleTitle
Can thickness of subcutaneous fat tissue limit emergency percutaneous cricothyrotomy?
Journal
Issue
Article type
Original article
Pages
128-133
Published online
2022-04-19
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4486
Article views/downloads
358
DOI
Bibliographic record
Medical Research Journal 2022;7(2):128-133.
Keywords
Cricothyrotomy
difficult neck anatomy
emergency airway management
needle cricothyrotomy
obesity
Authors
Tomasz Sanak
Ositadima Chukwu
Anna Gabryś
Jakub Giliavas
Katarzyna Ciuk
Marta Kalek
Andrzej Urbanik
References (14)- Hamaekers AE, Henderson JJ. Equipment and strategies for emergency tracheal access in the adult patient. Anaesthesia. 2011; 66 Suppl 2: 65–80.
- Manoj K Mittal, MD, ML, MRCP (UK), Needle cricothyroidotomy with percutaneous transtracheal ventilation. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA. https://www.uptodate.com/contents/needle-cricothyroidotomy-with-percutaneous-transtracheal-ventilation#H666923073 (10.12.2021).
- Regulation of the Minister of Health from 16 December 2019 on medical rescue activities and health services other than medical rescue activities that may be provided by a paramedic; Rozporządzenie Ministra Zdrowia z dnia 16 grudnia 2019 r. w sprawie medycznych czynności ratunkowych i świadczeń zdrowotnych innych niż medyczne czynności ratunkowe, które mogą być udzielane przez ratownika medycznego (Dz. U. z 2019 r., poz. 2478). https://isap.sejm.gov.pl/isap.nsf/DocDetails.xsp?id=WDU20190002478 (10.12.2021).
- Hossfeld B, Mahler O, Mayer B, et al. Necessity to depict difficult neck anatomy for training of cricothyroidotomy. Eur J Anaesthesiol. 2019; 36(7): 516–523.
- Afshin A, Forouzanfar MH, Reitsma MB, et al. GBD 2015 Obesity Collaborators. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med. 2017; 377(1): 13–27.
- Bein B, Höcker J, Fudickar A, et al. [Anaesthesia management of the obese patient]. Anasthesiol Intensivmed Notfallmed Schmerzther. 2009; 44(9): quiz 610.
- Wolff J. The Human Right to Health (Norton Global Ethics Series) . WW Norton & Company, New York 2012.
- Zengerink I, Brink PR, Laupland KB, et al. Needle thoracostomy in the treatment of a tension pneumothorax in trauma patients: what size needle? J Trauma. 2008; 64(1): 111–114.
- Carter TE, Mortensen CD, Kaistha S, et al. Needle decompression in appalachia do obese patients need longer needles? West J Emerg Med. 2013; 14(6): 650–652.
- Laan DV, Vu TD, Thiels CA, et al. Chest wall thickness and decompression failure: a systematic review and meta-analysis comparing anatomic locations in needle thoracostomy. Injury. 2016; 47(4): 797–804.
- Katayama A, Watanabe K, Tokumine J, et al. Cricothyroidotomy needle length is associated with posterior tracheal wall injury: a randomized crossover simulation study (CONSORT). Medicine (Baltimore). 2020; 99(9): e19331.
- Rehm CG, Wanek SM, Gagnon EB, et al. Cricothyroidotomy for elective airway management in critically ill trauma patients with technically challenging neck anatomy . Crit Care. 2002; 6(6): 531–535.
- Frerk C, Mitchell VS, McNarry AF, et al. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaesth. 2015; 115(6): 827–848.
- Heymans F, Feigl G, Graber S, et al. Emergency cricothyrotomy performed by surgical airway-naive medical personnel: a randomized crossover study in cadavers comparing three commonly used techniques. Anesthesiology. 2016; 125(2): 295–303.