Comparison of emergency surgical cricothyroidotomy and percutaneous cricothyroidotomy by experienced airway providers in an obese, <italic style="font-style: italic">in vivo</italic> porcine hemorrhage airway model

Tomas Karlsson; Andreas Brännström; Mikael Gellerfors; Jenny Gustavsson; Mattias Günther

doi:10.1186/s40779-022-00418-8

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Comparison of emergency surgical cricothyroidotomy and percutaneous cricothyroidotomy by experienced airway providers in an obese, in vivo porcine hemorrhage airway model

RESEARCH | Updated：2023-09-05

- Comparison of emergency surgical cricothyroidotomy and percutaneous cricothyroidotomy by experienced airway providers in an obese, in vivo porcine hemorrhage airway model
- Military Medical Research Vol. 10, Issue 4, Pages: 421-430(2023)
- Affiliations：
  
  1.Department of Clinical Science and Education, Section of Anesthesiology and Intensive Care, Karolinska Institute, 11883 Stockholm, Sweden
  2.Department of Neuroscience, Karolinska Institute, 17177 Stockholm, Sweden
  3.Department of Physiology and Pharmacology, Section of Anesthesiology and Intensive Care, Karolinska Institute, 11883 Stockholm, Sweden
  4.Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, 17177 Stockholm, Sweden
  5.Swedish Air Ambulance (SLA), 79291 Mora, Sweden
  6.Rapid Response Cars, 18233 Stockholm, Sweden
- Author bio：
  
  * tomas.karlsson@ki.se
- Funds：
- DOI：10.1186/s40779-022-00418-8
  CLC：
- Published：2023-08
- Accepted：
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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(1):57.
DOI：

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(1):57. DOI： 10.1186/s40779-022-00418-8.

摘要

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 [(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" (

=6) or scalpel-bougie-tube technique "surgical cricothyroidotomy" (

=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 (

=0.0152)

arterial blood saturation (SaO

) were 74.7 (IQR 46.6–84.2)% and 7.9 (IQR 4.1–15.6)% (

=0.0167)

PaO

were 7.0 (IQR 4.7–7.7) kPa and 2.0 (IQR 1.1–2.9) kPa (

=0.0667)

and times of cardiac arrest (proxy survival) were 137–233 s

190 (IQR 143–229) s

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.

Conclusions:

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 situ

ations with hemorrhage and CICO

in obese patients.

关键词

Keywords

references

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Tomas Karlsson

Andreas Brännström

Mikael Gellerfors

Jenny Gustavsson

Mattias Günther

Related Institution

Department of Clinical Science and Education, Section of Anesthesiology and Intensive Care, Karolinska Institutet

Department of Neuroscience, Karolinska Institutet

Department of Physiology and Pharmacology, Section of Anesthesiology and Intensive Care, Karolinska Institutet

⁰

Comparison of emergency surgical cricothyroidotomy and percutaneous cricothyroidotomy by experienced airway providers in an obese, in vivo porcine hemorrhage airway model

DOI：10.1186/s40779-022-00418-8

摘要

Abstract

关键词

Keywords

references