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Weimer AM, Weimer JM, Jonck C, Müller L, Stäuber M, Chrissostomou CD, Buggenhagen H, Klöckner R, Pirlich N, Künzel J, Rink M. [Ultrasound supported identification of the ligamentum conicum in teaching head and neck sonography]. Laryngorhinootologie 2024. [PMID: 38830381 DOI: 10.1055/a-2311-4389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
OBJECTIVE Upper airway obstructions are usually acute emergencies. Coniotomy is the last option to secure the airway and can be supported by sonography. The aim of this study was to establish a training program to teach these skills. MATERIAL AND METHODS The training consisted of theoretical training with an additional video presentation (10 minutes each) and practical training (45 minutes). Evaluations were completed before (T1) and after (T2) the training to measure prior experience and satisfaction with the training as well as subjective and objective competence levels. At T2, a practical test was also completed by n=113 participants. A standardized evaluation form was used to document the results of the practical test. RESULTS A large proportion of the participants had neither seen a coniotomy (64.6%) nor performed one independently (79.6%). Significant improvement (T1 to T2) was measured with regard to the subjective assessment of competence (p<0.001). The training received positive ratings for all items tested (scale ranges 1-2). During practical tests, the participants achieved an average of 89.2% of the possible points and needed a mean of 101 ±23 seconds to identify the conic ligament. CONCLUSION Structured training for sonographic identification of the conic ligament leads to significant improvement in the subjective assessment of competence and a high objective competence level in a short period of time. This type of training should be standardized in head and neck ultrasound training in the future.
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Affiliation(s)
- Andreas Michael Weimer
- Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Johannes Matthias Weimer
- Rudolf Frey Lernklinik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - Christopher Jonck
- Rudolf Frey Lernklinik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - Lukas Müller
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - Marie Stäuber
- Rudolf Frey Lernklinik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | | | - Holger Buggenhagen
- Rudolf Frey Lernklinik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - Roman Klöckner
- Institut für Interventionelle Radiologie, Universitätsklinikum Schleswig-Holstein Campus Lübeck, Lubeck, Germany
| | - Nina Pirlich
- Klinik für Anästhesiologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - Julian Künzel
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Maximilian Rink
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Regensburg, Regensburg, Germany
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Cheung VKL, Chia NH, So SS, Ng GWY, So EHK. Expanding scope of Kirkpatrick model from training effectiveness review to evidence-informed prioritization management for cricothyroidotomy simulation. Heliyon 2023; 9:e18268. [PMID: 37560697 PMCID: PMC10407669 DOI: 10.1016/j.heliyon.2023.e18268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 06/21/2023] [Accepted: 07/12/2023] [Indexed: 08/11/2023] Open
Abstract
Modified Kirkpatrick model has been adopted to evaluate training effectiveness by 6 categories, including activity accounting (training objectives/success in organization change) at Level-0, reaction (satisfaction) at Level-1, learning (acquisition of surgical airway skills) at Level-2, behavior (post-training change in personal strengths) at Level-3, result (organizational or clinical outcomes) at Level-4, and Return on Investment (ROI) or Expectation (ROE) (monetary and societal values following training and other quality and safety related measures) at Level-5. The purpose of this hospital-based prospective observational study was twofold: i) To evaluate potential impacts on monetary and societal values and successful organization change following implementation of advanced Cricothyroidotomy simulator and standardized curriculum in healthcare simulation training, ii) To inform decisions of resource allocation by reviewing overall values and prioritization strategies for i) general surgeon/emergency physician ii) with seniority >5 years and iii) prior porcine training experience based on findings at Kirkpatrick Level-0, Level-4, and Level-5. Seventy doctors and 10 nurses completed Cricothyroidotomy training and follow-up questionnaires within 2021/22. All training usability scoring measured by Scales of Emergency Surgical Airway Simulator (SESAS-17) achieved over 4 out of 5 (Level-4) with effects in favor of emergency physicians or general surgeons (p < .5), regardless of seniority and prior training experience. Success in organization change (Level-0) and cost-effectiveness (Level-5) were hypothetically established using theoretical framework of Gleicher's formula and Roger's Diffusion of Innovation Theory. Overall training effectiveness, in terms of advantage in usability, cost-benefits and successful organizational changes, provided sound evidence to support continuous investment of new curriculum and innovative simulator and "Surgeon-and-emergency-physician-first" policy when it comes to resources allocation strategies for Cricothyroidotomy training. [ACGME competencies: Practice Based Learning and Improvement, Systems Based Practice.].
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Affiliation(s)
- Victor Kai-Lam Cheung
- Multi-Disciplinary Simulation & Skills Centre (MDSSC), Queen Elizabeth Hospital, Hong Kong Special Administrative Region
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, UK
| | - Nam-Hung Chia
- Multi-Disciplinary Simulation & Skills Centre (MDSSC), Queen Elizabeth Hospital, Hong Kong Special Administrative Region
- Department of Surgery, Queen Elizabeth Hospital, Hong Kong Special Administrative Region
| | - Sze-Sze So
- Multi-Disciplinary Simulation & Skills Centre (MDSSC), Queen Elizabeth Hospital, Hong Kong Special Administrative Region
| | - George Wing-Yiu Ng
- Multi-Disciplinary Simulation & Skills Centre (MDSSC), Queen Elizabeth Hospital, Hong Kong Special Administrative Region
- Intensive Care Unit, Queen Elizabeth Hospital, Hong Kong Special Administrative Region
| | - Eric Hang-Kwong So
- Multi-Disciplinary Simulation & Skills Centre (MDSSC), Queen Elizabeth Hospital, Hong Kong Special Administrative Region
- Department of Anaesthesiology & Operating Theatre Services, Queen Elizabeth Hospital, Hong Kong Special Administrative Region
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Duan Q, Yang D, Gao H, Liu Q, Zhi J, Xu J, Xia W. Scalpel cricothyrotomy versus punctured cricothyrotomy in the context of the CICO crisis. A systematic review and Meta-analysis. Anaesth Crit Care Pain Med 2023; 42:101211. [PMID: 36871625 DOI: 10.1016/j.accpm.2023.101211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/14/2023] [Accepted: 02/25/2023] [Indexed: 03/07/2023]
Abstract
IMPORTANCE The preferential use of a scalpel (SCT) or puncture techniques (PCT) for cricothyrotomy remains a controversial topic. OBJECTIVE We performed a systematic review and meta-analysis comparing puncture cricothyrotomy with scalpel cricothyrotomy using overall success rate, first-time success rate, and time taken to perform the procedure as the primary outcome together with complications as a secondary outcome. EVIDENCE REVIEW Pubmed databases, EMBASE databases, MEDLINE, Google Scholar, and Cochrane Central Register of Controlled Trials, from 1980 to October 2022. FINDINGS A total of 32 studies were included in the systematic review and meta-analysis. It also showed that PCT was close to SCT in terms of overall success rate (82.2% vs. 82.6%, Odd Ratios OR = 0.91, [95%CI: 0.52-1.58], p = 0.74) as well as first-performance success rate (62.9% vs. 65.3%, OR = 0.52, [0.22-1.25], p = 0.15). PCT does not compare favorably with SCT in terms of required time for the procedure (the mean time required for PCT versus SCT incision in the intervention groups was 0.34 standard deviations higher (Mean Difference MD = 17.12, [3.37-30.87], p = 0.01) as well as complications (21.4% vs. 15.1%, Relative Risk RR = 1.49, [0.80-2.77], p = 0.21). CONCLUSIONS AND RELEVANCE The results show that SCT has an advantage over PCT in terms of time required for the procedure, while there is no difference in overall success rate, first-time success rate after training, and complications. The superiority of SCT may be the result of fewer and more reliable procedural steps. However, the level of evidence is low (GRADE).
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Affiliation(s)
- Qirui Duan
- Department of Anesthesia, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dong Yang
- Department of Anesthesia, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Huibin Gao
- Department of Anesthesia, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Quanle Liu
- Department of Anesthesia, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Juan Zhi
- Department of Anesthesia, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jin Xu
- Department of Anesthesia, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weipeng Xia
- Department of Anesthesia, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Karlsson T, Brännström A, Gellerfors M, Gustavsson J, Günther M. Comparison of emergency surgical cricothyroidotomy and percutaneous cricothyroidotomy by experienced airway providers in an obese, in vivo porcine hemorrhage airway model. Mil Med Res 2022; 9:57. [PMID: 36217208 PMCID: PMC9552401 DOI: 10.1186/s40779-022-00418-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 09/20/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Emergency front-of-neck airway (eFONA) is a life-saving procedure in "cannot intubate, cannot oxygenate" (CICO). The fastest and most reliable method of eFONA has not been determined. We compared two of the most advocated approaches: surgical cricothyroidotomy and percutaneous cricothyroidotomy, in an obese, in vivo porcine hemorrhage model, designed to introduce real-time physiological feedback, relevant and high provider stress. The primary aim was to determine the fastest method to secure airway. Secondary aims were arterial saturation and partial pressure of oxygen, proxy survival and influence of experience. METHODS Twelve pigs, mean weight (standard deviation, SD) (60.3 ± 4.1) kg, were anesthetized and exposed to 25-35% total blood volume hemorrhage before extubation and randomization to Seldinger technique "percutaneous cricothyroidotomy" (n = 6) or scalpel-bougie-tube technique "surgical cricothyroidotomy" (n = 6). Specialists in anesthesia and intensive care in a tertiary referral hospital performed the eFONA, simulating an actual CICO-situation. RESULTS In surgical cricothyroidotomy vs. percutaneous cricothyroidotomy, the median (interquartile range, IQR) times to secure airway were 109 (IQR 71-130) s and 298 (IQR 128-360) s (P = 0.0152), arterial blood saturation (SaO2) were 74.7 (IQR 46.6-84.2) % and 7.9 (IQR 4.1-15.6) % (P = 0.0167), pO2 were 7.0 (IQR 4.7-7.7) kPa and 2.0 (IQR 1.1-2.9) kPa (P = 0.0667), and times of cardiac arrest (proxy survival) were 137-233 s, 190 (IQR 143-229), from CICO. All six animals survived surgical cricothyroidotomy, and two of six (33%) animals survived percutaneous cricothyroidotomy. Years in anesthesia, 13.5 (IQR 7.5-21.3), did not influence time to secure airway. CONCLUSION eFONA by surgical cricothyroidotomy was faster and had increased oxygenation and survival, when performed under stress by board certified anesthesiologists, and may be an indication of preferred method in situations with hemorrhage and CICO, in obese patients.
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Affiliation(s)
- Tomas Karlsson
- Department of Clinical Science and Education, Section of Anesthesiology and Intensive Care, Karolinska Institutet, 11883, Stockholm, Sweden.
| | - Andreas Brännström
- Department of Neuroscience, Karolinska Institutet, 17177, Stockholm, Sweden
| | - Mikael Gellerfors
- Department of Physiology and Pharmacology, Section of Anesthesiology and Intensive Care, Karolinska Institutet, 11883, Stockholm, Sweden.,Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, 17177, Stockholm, Sweden.,Swedish Air Ambulance (SLA), 79291, Mora, Sweden.,Rapid Response Cars, 18233, Stockholm, Sweden
| | - Jenny Gustavsson
- Department of Neuroscience, Karolinska Institutet, 17177, Stockholm, Sweden
| | - Mattias Günther
- Department of Clinical Science and Education, Section of Anesthesiology and Intensive Care, Karolinska Institutet, 11883, Stockholm, Sweden.,Department of Neuroscience, Karolinska Institutet, 17177, Stockholm, Sweden
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Harnessing power of simulation training effectiveness with Kirkpatrick model in emergency surgical airway procedures. Heliyon 2022; 8:e10886. [PMID: 36267377 PMCID: PMC9576887 DOI: 10.1016/j.heliyon.2022.e10886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/22/2022] [Accepted: 09/28/2022] [Indexed: 11/06/2022] Open
Abstract
Objectives Training effectiveness indicates how good a program has met pre-set training objectives or organizational goals for the best benefit of healthcare professionals and service users in the community. The study aimed to evaluate training effectiveness following implementation of new training curriculum of emergency surgical airway procedures (Cricothyroidotomy) organized by the Queen Elizabeth Hospital. Design This training evaluation relied on observational descriptive study design. Timed task on Cricothyroidotomy procedures and standardized post-training questionnaire were applied to assess the first 3 levels of Kirkpatrick's model: (Level-1) Reaction by training satisfaction; (Level-2) Learning by acquisition of knowledge and skills assessment passing rate; (Level-3) Behavior by personal strengths. Setting This program was operated in the Multi-Disciplinary Simulation and Skills Centre, a hospital-based high-fidelity simulation training center accredited by the Society for Simulation in Healthcare. Participants The study recruited 80 trauma service providers, including 35 general surgeons, 15 emergency physicians, 10 anesthesiologists or intensivists, 6 neurosurgeons, 4 orthopedic surgeons, and 10 emergency nurses from five trauma centers under the Hospital Authority. All underwent the Advanced Trauma Life Support training in advance. Results Compared with reference score from previous training sessions, the result of program using new training curriculum and simulator demonstrated significant training satisfaction of participants (Level-1), and high level of assertiveness, mental preparedness, self-efficacy, and internal locus of control and responsibility (p < .01, for all in Level-3). All participants (N = 80) completed entire Cricothyroidotomy procedure in 2 min without technical errors (Assessment passing rate = 100%) (Level-2). Conclusions Under Kirkpatrick model, simulation training in Cricothyroidotomy procedure using new curriculum and simulators has been proven to be useful for healthcare professionals involved in trauma service management. The result suggests that application of a state-of-the-art training tools to advanced surgical skills training could improve training satisfaction, knowledge and skills acquisition, and personal strengths transferable to clinical practice. ACGME competencies Practice Based Learning and Improvement.
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Song JL, Sun Y, Shi YB, Liu XY, Su ZB. Comparison of the effectiveness of high-flow nasal oxygen vs. standard facemask oxygenation for pre- and apneic oxygenation during anesthesia induction: a systematic review and meta-analysis. BMC Anesthesiol 2022; 22:100. [PMID: 35387583 PMCID: PMC8985355 DOI: 10.1186/s12871-022-01615-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 03/14/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND In recent years, high flow nasal oxygen (HFNO) has been widely used in clinic, especially in perioperative period. Many studies have discussed the role of HFNO in pre- and apneic oxygenation, but their results are controversial. Our study aimed to examine the effectiveness of HFNO in pre- and apneic oxygenation by a meta-analysis of RCTs. METHODS EMBASE, PUBMED, and COCHRANE LIBRARY databases were searched from inception to July 2021 for relevant randomized controlled trails (RCTs) on the effectiveness of HFNO versus standard facemask ventilation (FMV) in pre- and apenic oxygenation. Studies involving one of the following six indicators: (1) Arterial oxygen partial pressure (PaO2), (2) End expiratory oxygen concentration (EtO2), (3) Safe apnoea time, (4) Minimum pulse oxygen saturation (SpO2min), (5) Oxygenation (O2) desaturation, (6) End expiratory carbon dioxide (EtCO2) or Arterial carbon dioxide partial pressure(PaCO2) were included. Due to the source of clinical heterogeneity in the observed indicators in this study, we adopt random-effects model for analysis, and express it as the mean difference (MD) or risk ratio (RR) with a confidence interval of 95% (95%CI). We conducted a risk assessment of bias for eligible studies and assessed the overall quality of evidence for each outcome. RESULTS Fourteen RCTs and 1012 participants were finally included. We found the PaO2 was higher in HFNO group than FMV group with a MD (95% CI) of 57.38 mmHg (25.65 to 89.10; p = 0.0004) after preoxygenation and the safe apnoea time was significantly longer with a MD (95% CI) of 86.93 s (44.35 to 129.51; p < 0.0001) during anesthesia induction. There were no significant statistical difference in the minimum SpO2, CO2 accumulation, EtO2 and O2 desaturation rate during anesthesia induction between the two groups. CONCLUSIONS This systematic review and meta-analysis suggests that HFNO should be considered as an oxygenation tool for patients during anesthesia induction. Compared with FMV, continuous use of HFNO during anesthesia induction can significantly improve oxygenation and prolong safe apnoea time in surgical patients.
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Affiliation(s)
- Jian-li Song
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, No. 126, Xiantai Rd, Changchun, 130000 China
| | - Yan Sun
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, No. 126, Xiantai Rd, Changchun, 130000 China
| | - Yu-bo Shi
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, No. 126, Xiantai Rd, Changchun, 130000 China
| | - Xiao-ying Liu
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, No. 126, Xiantai Rd, Changchun, 130000 China
| | - Zhen-bo Su
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, No. 126, Xiantai Rd, Changchun, 130000 China
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Nam IC, Shin YS, Jeong WJ, Park MW, Park SY, Song CM, Lee YC, Jeon JH, Lee J, Kang CH, Park IS, Kim K, Sun DI. Guidelines for Tracheostomy From the Korean Bronchoesophagological Society. Clin Exp Otorhinolaryngol 2020; 13:361-375. [PMID: 32717774 PMCID: PMC7669309 DOI: 10.21053/ceo.2020.00353] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 05/19/2020] [Indexed: 12/17/2022] Open
Abstract
The Korean Bronchoesophagological Society appointed a task force to develop a clinical practice guideline for tracheostomy. The task force conducted a systematic search of the Embase, Medline, Cochrane Library, and KoreaMed databases to identify relevant articles, using search terms selected according to key questions. Evidence-based recommendations for practice were ranked according to the American College of Physicians grading system. An external expert review and a Delphi questionnaire were conducted to reach a consensus regarding the recommendations. Accordingly, the committee developed 18 evidence-based recommendations, which are grouped into seven categories. These recommendations are intended to assist clinicians in performing tracheostomy and in the management of tracheostomized patients.
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Affiliation(s)
| | - Inn-Chul Nam
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoo Seob Shin
- Department of Otolaryngology-Head and Neck Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Woo-Jin Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Min Woo Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Seong Yong Park
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Myeon Song
- Department of Otolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Young Chan Lee
- Department of Otolaryngology-Head and Neck Surgery, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jae Hyun Jeon
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jongmin Lee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chang Hyun Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Il-Seok Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Kwhanmien Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Il Sun
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Katayama A, Watanabe K, Tokumine J, Lefor AK, Nakazawa H, Jimbo I, Yorozu T. Cricothyroidotomy needle length is associated with posterior tracheal wall injury: A randomized crossover simulation study (CONSORT). Medicine (Baltimore) 2020; 99:e19331. [PMID: 32118765 PMCID: PMC7478458 DOI: 10.1097/md.0000000000019331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Cricothyroidotomy is the final strategy in the "cannot intubate, cannot oxygenate" scenario, but half of needle cricothyroidotomy attempts result in failure. The most frequent complication in needle cricothyroidotomy is posterior tracheal wall injury. We hypothesized that needle length is related to posterior wall injury and compared needle cricothyroidotomy with a commercial kit to a modified shorter needle to evaluate success and posterior wall injury rates. METHODS The commercial kit has a needle stopper to prevent posterior wall injury, with a penetrating length of 25 mm. We made long stopper to shorten the length by 5 mm (net 20 mm penetrating length). Residents were recruited, received a lecture about cricothyroidotomy and practiced needle cricothyroidotomy using the commercial kit on a simulator. They then performed cricothyroidotomy using the commercial kit or the shorter needle on an ex-vivo porcine larynx covered with artificial skin. An intra-tracheal endoscope recorded the procedure. The video was evaluated for success/failure or posterior wall injury by independent evaluators. Larynxes with a distance from the outer surface to the inner lumen exceeding 13 mm were excluded. The distance in each larynx was measured by dissection after the study. Success and posterior wall injury rates were analyzed using Fisher exact test (P < .05 was statistically significant). RESULTS Forty-seven residents participated in the study. Data for two residents were excluded. There was no statistically significant difference in success rate between the commercial kit (100%, 45/45) and the shorter needle (91%, 41/45, P = .12). Failure was defined if the needle tip did not reach the lumen in four trials. Cannulated but complicated by posterior wall injury occurred in 33% (15/45) with the commercial kit and 5% (2/43) with the shorter needle (P < .01). CONCLUSION During needle cricothyroidotomy, force is needed for the needle to penetrate the cricothyroid ligament. The advancing needle sometimes cannot be stopped after penetrating the cricothyroid ligament. These data suggest that needle length is associated with posterior wall injury.
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Affiliation(s)
- Atsuko Katayama
- Department of Anesthesiology, Kyorin University School of Medicine, Sinkawa, Mitaka, Tokyo
| | - Kunitaro Watanabe
- Department of Anesthesiology, Kyorin University School of Medicine, Sinkawa, Mitaka, Tokyo
| | - Joho Tokumine
- Department of Anesthesiology, Kyorin University School of Medicine, Sinkawa, Mitaka, Tokyo
| | | | - Harumasa Nakazawa
- Department of Anesthesiology, Kyorin University School of Medicine, Sinkawa, Mitaka, Tokyo
| | - Ippei Jimbo
- Department of Anesthesiology, Kyorin University School of Medicine, Sinkawa, Mitaka, Tokyo
| | - Tomoko Yorozu
- Department of Anesthesiology, Kyorin University School of Medicine, Sinkawa, Mitaka, Tokyo
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Andresen ÅEL, Kramer‐Johansen J, Kristiansen T. Percutaneous vs surgical emergency cricothyroidotomy: An experimental randomized crossover study on an animal-larynx model. Acta Anaesthesiol Scand 2019; 63:1306-1312. [PMID: 31287154 DOI: 10.1111/aas.13447] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 06/17/2019] [Accepted: 06/18/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Airway management is a paramount clinical skill for the anaesthesiologist. The Emergency Cricothyroidotomy (EC) constitutes the final step in difficult airway algorithms securing a patent airway via a front-of-neck access. The main distinction among available techniques is whether the procedure is surgical and scalpel-based or percutaneous and needle-based. METHODS In an experimental randomized crossover trial, using an animal larynx model, we compared two EC techniques; the Rapid Four Step Technique and the Melker Emergency Cricothyrotomy Kit®. We assessed time expenditure and success rates among 20 anaesthesiologists and related this to previous training, seniority and clinical experience with EC. RESULTS All participants achieved successful airway access with both methods. Average time to successful airway access for scalpel-based EC was 54 (±31) seconds and for percutaneous EC 89 (±38) seconds, with 35 (95% CI: 14-57) seconds time difference, P = .003. Doctors with recent (<12 months) EC training performed better compared to the non-training group (37 vs 61 seconds, P = .03 for scalpel-based EC, and 65 vs 99 seconds, P = .02 for percutaneous EC). We found no differences according to clinical seniority or previous real-life EC experience. CONCLUSIONS Our study demonstrated that anaesthesiologists achieved successful airway access on an animal experimental model with both EC methods within a reasonable time frame, but the scalpel-based EC is performed more promptly. Recent EC training affected the time expenditure positively, while seniority and clinical EC experience did not. EC procedures should be regularly trained for.
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Affiliation(s)
- Åke Erling L. Andresen
- Department of Research Norwegian Air Ambulance Foundation Oslo Norway
- Department of Anaesthesiology and Intensive Care Vestre Viken Hospital Trust Drammen Norway
| | - Jo Kramer‐Johansen
- Division of Prehospital Services, Institute of Clinical Medicine University of Oslo Oslo Norway
- Norwegian National Advisory Unit on Prehospital Emergency Medicine Oslo University Hospital Oslo Norway
| | - Thomas Kristiansen
- Department of Anaesthesiology, Division of Emergencies and Critical Care Oslo University Hospital, Rikshospitalet Oslo Norway
- Division of Emergencies and Critical Care Institute of Clinical Medicine, University of Oslo Oslo Norway
- Norwegian National Advisory Unit on Trauma, Division of Emergencies and Critical Care Oslo University Hospital Oslo Norway
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Rees KA, O'Halloran LJ, Wawryk JB, Gotmaker R, Cameron EK, Woonton HDJ. Time to oxygenation for cannula‐ and scalpel‐based techniques for emergency front‐of‐neck access: a wet lab simulation using an ovine model. Anaesthesia 2019; 74:1153-1157. [DOI: 10.1111/anae.14706] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2019] [Indexed: 11/30/2022]
Affiliation(s)
- K. A. Rees
- Department of Anaesthesia Monash Medical Centre Melbourne VIC Australia
| | - L. J. O'Halloran
- Department of Anaesthesia Monash Medical Centre Melbourne VIC Australia
| | - J. B. Wawryk
- Department of Anaesthesia Townsville Hospital Townsville QLD Australia
| | - R. Gotmaker
- Department of Anaesthesia St. Vincent's Hospital Melbourne VIC Australia
| | - E. K. Cameron
- Department of Anaesthesia Monash Medical Centre Melbourne VIC Australia
| | - H. D. J. Woonton
- Department of Anaesthesia Monash Medical Centre Melbourne VIC Australia
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McCracken GC. Statistical significance comparing cricothyroidotomy techniques. Anaesthesia 2019; 74:249-250. [PMID: 30656661 DOI: 10.1111/anae.14551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Comparative Anatomy of Pig Arytenoid Cartilage and Human Arytenoid Cartilage. J Voice 2018; 33:620-626. [PMID: 30017432 DOI: 10.1016/j.jvoice.2018.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 02/20/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study aims to investigate the feasibility of pig arytenoid cartilage as an animal model for simulating arytenoidectomy under microlaryngoscope by comparing the similarities and differences between pig arytenoid cartilage and human arytenoid cartilage. STUDY DESIGN This is a methodological study on the excised pig arytenoid cartilage and human arytenoid cartilage. METHODS Five excised human adult cadaver larynges and five adult excised porcine larynges were dissected and all the soft tissue and mucous membrane attached to the arytenoid and cricoarytenoid joint were removed. The anatomical structure and morphology of the arytenoid cartilage were observed and measured with a vernier caliper. Measurements included cricoarytenoid articular facet major and minor diameter, cricoarytenoid articular facet center distance, cricoarytenoid facet major and minor diameter, length of vocal process and muscular process, and distance between tip of vocal process, muscular process, and junction/apex of arytenoid cartilage. Data were then compared across these major anatomic markers using student t test. RESULTS The gross anatomy of the pig arytenoid cartilage was similar to the human. However, the size of the pig larynx arytenoid cartilage was obviously larger in total, and there was statistical significance for almost all measurements (P < 0.05), except the mean value of cricoarytenoid articular facet center distance, the cricoarytenoid facet minor diameter, and the length of vocal process of pig and human, without statistically significant difference (P > 0.05). Moreover, the biggest differences between the pig arytenoid cartilage and the human arytenoid cartilage were that the pig arytenoid cartilage apex had the angle winding structure toward the back, and that the posterior part of the bilateral arytenoid cartilages was partially connected. Whereas after the angle winding was removed from the junction, pig arytenoid cartilage and human arytenoid cartilage were shaped both like a triangular pyramid. CONCLUSION The data of this metric comparative study indicate that pig arytenoid, after resecting the angle winding structure and incising the interarytenoid cartilage, is similar to the human's. Therefore, pig larynx is an appropriate experimental model for endoscopic arytenoidectomy. In addition, regarding the pig laryngeal angle winding structure, we still require further basic and clinical research to clarify its physiological function and significance.
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Yeow C, Greaney L, Foy C, King W, Patel B. Evaluation of a novel cricothyroidotomy introducer in a simulated obese porcine model: a randomised crossover comparison with scalpel cricothyroidotomy. Anaesthesia 2018; 73:1235-1243. [DOI: 10.1111/anae.14321] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2018] [Indexed: 11/28/2022]
Affiliation(s)
- C. Yeow
- Department of Anaesthesia Royal Surrey County Hospital Guildford UK
| | - L. Greaney
- Department of Oral and Maxillofacial Surgery Royal Surrey County Hospital Guildford UK
| | - C. Foy
- Gloucestershire Research Support Service Gloucestershire Royal Hospital Gloucester UK
| | - W. King
- Department of Anaesthesia Royal Surrey County Hospital Guildford UK
| | - B. Patel
- Department of Anaesthesia Royal Surrey County Hospital Guildford UK
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Pairaudeau CF, Mendonca C, Hillermann C, Qazi I, Baker PA, Hodgson RE, Radhakrishna S. Effect of palpable vs. impalpable cricothyroid membranes in a simulated emergency front-of-neck access scenario. Anaesthesia 2018; 73:579-586. [DOI: 10.1111/anae.14218] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2017] [Indexed: 11/29/2022]
Affiliation(s)
- C. F. Pairaudeau
- Department of Anaesthesia; University Hospitals Coventry and Warwickshire NHS Trust; Coventry UK
| | - C. Mendonca
- Department of Anaesthesia; University Hospitals Coventry and Warwickshire NHS Trust; Coventry UK
| | - C. Hillermann
- Department of Anaesthesia; University Hospitals Coventry and Warwickshire NHS Trust; Coventry UK
| | - I. Qazi
- Department of Anaesthesia; University Hospitals Coventry and Warwickshire NHS Trust; Coventry UK
| | - P. A. Baker
- Department of Anesthesiology; University of Auckland; New Zealand
| | - R. E. Hodgson
- Department of Anesthesiology; Inkosi Albert Luthuli Central Hospital; eThekwini-Durban South Africa
| | - S. Radhakrishna
- Department of Anaesthesia; University Hospitals Coventry and Warwickshire NHS Trust; Coventry UK
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Chrisman L, King W, Wimble K, Cartwright S, Mohammed K, Patel B. Surgicric 2: A comparative bench study with two established emergency cricothyroidotomy techniques in a porcine model. Br J Anaesth 2016; 117:236-42. [DOI: 10.1093/bja/aew174] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2016] [Indexed: 12/13/2022] Open
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