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DeSchmidt AM, Gong AT, Batista JE, Song AY, Bidinger SL, Schul AL, Wang EY, Norfleet JE, Sweet RM. Characterization of Puncture Forces of the Human Trachea and Cricothyroid Membrane. J Biomech Eng 2022; 144:1140296. [PMID: 35445243 DOI: 10.1115/1.4054380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Indexed: 12/12/2022]
Abstract
Accurate human tissue biomechanical data represents a critical knowledge gap that will help facilitate the advancement of new medical devices, patient-specific predictive models, and training simulators. Tissues related to the human airway are a top priority, as airway medical procedures are common and critical. Placement of a surgical airway, though less common, is often done in an emergent (cricothyrotomy) or urgent (tracheotomy) fashion. This study is the first to report relevant puncture force data for the human cricothyroid membrane and tracheal annular ligaments. Puncture forces of the cricothyroid membrane and tracheal annular ligaments were collected from 39 and 42 excised human donor tracheas, respectively, with a mechanized load frame holding various surgical tools. The average puncture force of the cricothyroid membrane using an 11 blade scalpel was 1.01 ± 0.36 N, and the average puncture force of the tracheal annular ligaments using a 16 gauge needle was 0.98 ± 0.34 N. This data can be used to inform medical device and airway training simulator development as puncture data of these anatomies has not been previously reported.
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Affiliation(s)
- Aleah M DeSchmidt
- Department of Surgery, University of Washington, 1959 NE Pacific Ave Magnuson Health Sciences T293, Seattle, WA 98195-0000; Department of Bioengineering, University of Washington, 1959 NE Pacific Ave Magnuson Health Sciences T293, Seattle, WA 98195-0000
| | - Alex T Gong
- Department of Surgery, University of Washington, 1959 NE Pacific Ave Magnuson Health Sciences T293, Seattle, WA 98195-0000
| | | | - Agnes Y Song
- Department of Surgery, University of Washington, 1959 NE Pacific Ave Magnuson Health Sciences T293, Seattle, WA 98195-0000; Department of Bioengineering, University of Washington, 1959 NE Pacific Ave Magnuson Health Sciences T293, Seattle, WA 98195-0000
| | - Sophia L Bidinger
- Electrical Engineering Division, University of Cambridge, 9 JJ Thomson Avenue, Cambridge CB3 0FA, UK
| | - Alyssa L Schul
- Philips Healthcare, 22100 Bothell Everett Hwy, Bothell, WA 98021
| | - Everet Y Wang
- Department of Surgery, University of Washington, 1959 NE Pacific Ave Magnuson Health Sciences T293, Seattle, WA 98195-0000
| | - Jack E Norfleet
- Medical Simulation Research Branch Simulation and Training Technology Center, U.S. Army CCDC Soldier Center, 12423 Research Parkway, Orlando, FL 32826
| | - Robert M Sweet
- Department of Surgery, University of Washington, 1959 NE Pacific Ave Magnuson Health Sciences T293, Seattle, WA 98195-0000; Department of Urology, University of Washington, 1959 NE Pacific Ave Magnuson Health Sciences T293, Seattle, WA 98195-0000;Department of Bioengineering, University of Washington, 1959 NE Pacific Ave Magnuson Health Sciences T293, Seattle, WA 98195-0000
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Abstract
Close to 3% of all intubation attempts are considered difficult airways, for which a plan for a surgical airway should be considered. Our article provides an overview of the different types of surgical airways. This article provides a comprehensive review of the main types of surgical airways, relevant anatomy, necessary equipment, indications and contraindications, preparation and positioning, technique, complications, and tips for management. It is important to remember that the placement of a surgical airway is a lifesaving procedure and should be considered in any setting when one "cannot intubate, cannot ventilate".
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Affiliation(s)
- Sapna A Patel
- Department of Otolaryngology, University of Washington, Seattle, WA
| | - Tanya K Meyer
- Department of Otolaryngology, University of Washington, Seattle, WA
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