A new strategy for difficult airway management with visual needle cricothyroidotomy: a manikin study


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Abstract

BackgroundConventional needle cricothyroidotomy uses blind manipulation. We investigated the feasibility and efficiency of a new visually guided needle cricothyroidotomy technique.MethodsA 0.9-mm microimaging fiber was delivered into a 14G needle to develop a visual puncture system. 10 inexperienced physicians were randomly assigned to perform 10 repeated needle cricothyroidotomy in each group with both conventional method and visual puncture in a manikin. Tracheal lumen puncture time and number of procedure-related complications were recorded.ResultsUnder visual guidance, the needle successfully reached the tracheal lumen. The anatomy of the upper and lower airways was acquired by further advancing the microimaging fiber into the tracheal lumen of the visual group. The tracheal lumen puncture time was significantly less in the visual group than in the conventional group (3.85 ± 1.54 vs. 9.84 ± 1.08 seconds, P < .001). Damage to the posterior tracheal wall was not observed in the visual group; however, 21% of manikins in the conventional group had procedure-related complications.ConclusionsOur results demonstrate that visual needle cricothyroidotomy is feasible, and may lead to a decrease in procedure time and procedure-related complications compared to the conventional procedure. In addition, this strategy may also provide useful information for diagnostic purposes; therefore, visual needle cricothyroidotomy may be a new strategy for the management of difficult airways in future care.HighlightsA 0.9-mm microimaging fiber was delivered into a 14G needle to develop a visual puncture system.This study used this visual puncture system to perform needle cricothyroidotomy.To the best of our knowledge, this is the first experience to investigate the feasibility and efficiency of this video-assisted system for needle cricothyroidotomy in manikin.Under visual guidance, the needle tip of this visual puncture system was delivered into the tracheal lumen with proper position. In comparison to the conventional group, due to visual guidance, this new strategy had less procedure time and procedure-related complications.Moreover, the anatomy of both the upper and lower airways was acquired, which could provide useful information for diagnostic purposes. Therefore, visually guided needle cricothyroidotomy may be a new strategy for difficult airway management in future care.

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