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Am J Emerg Med. 2015 May;33(5):708-12. doi: 10.1016/j.ajem.2015.02.048. Epub 2015 Mar 7.

Combining transtracheal catheter oxygenation and needle-based Seldinger cricothyrotomy into a single, sequential procedure.

Author information

1
Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, USA. Electronic address: ericboccio@gmail.com.
2
Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, USA. Electronic address: rgujral@nshs.edu.
3
Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, USA. Electronic address: mcassara@nshs.edu.
4
Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, USA. Electronic address: tamato@nshs.edu.
5
Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, USA. Electronic address: bwie@nshs.edu.
6
Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, USA. Electronic address: mward@nshs.edu.
7
Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, USA. Electronic address: jdamore@nshs.edu.

Abstract

BACKGROUND:

Needle-based cricothyrotomy is a common procedure for emergency department patients requiring an emergent surgical airway. Percutaneous transtracheal jet ventilation is well studied to provide oxygenation. We propose to combine these procedures into a novel, single, and sequential procedure.

METHODS:

This study was a prospective manikin/human cadaver procedural feasibility study performed at a medical education center. Forty-eight emergency medicine attending physicians and fellows performed the procedure on a single TraumaMan (Simulab Corporation, Seattle, WA), and 26 were randomly selected to perform the procedure on fresh, unfixed human cadavers. The procedure is as follows: 15 gauge/6F catheter-over-needle punctures cricothyroid membrane, needle is removed, and Enk oxygen flow modulator is attached to the catheter (start to oxygenation). The Enk set is detached, a guide wire introduced, and Seldinger cricothyrotomy is performed (oxygenation to cricothyrotomy). Start-to-oxygenation, oxygenation-to-cricothyrotomy, and start-to-cricothyrotomy times were recorded. Manikin procedures were verified by direct visualization, and cadaver procedures were verified by video laryngoscopy.

RESULTS:

All attempts were included in data analysis, and there was a 100% first-pass success rate. For the manikin trials, median start-to-oxygenation, oxygenation-to-cricothyrotomy, and start-to-cricothyrotomy times with interquartile ranges were 11 (8.5-13), 48 (42-57), and 59 (53-69) seconds, respectively. For the cadaver trials, median start-to-oxygenation, oxygenation-to-cricothyrotomy, and start-to-cricothyrotomy times with interquartile ranges were 12 (10-15), 59 (47-76), and 71 (61-94) seconds, respectively. Student t tests showed significant differences in start-to-oxygenation and oxygenation-to-cricothyrotomy times (P < .01) within the manikin and cadaver groups.

CONCLUSION:

Percutaneous transtracheal jet ventilation and needle-based Seldinger cricothyrotomy can be performed by emergency medicine physicians, and a single, sequential procedure may significantly reduce time to oxygenation for patients already undergoing surgical cricothyrotomy.

PMID:
25791154
DOI:
10.1016/j.ajem.2015.02.048
[Indexed for MEDLINE]

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