PMID- 36217208
OWN - NLM
STAT- MEDLINE
DCOM- 20221012
LR  - 20221206
IS  - 2054-9369 (Electronic)
IS  - 2095-7467 (Print)
IS  - 2054-9369 (Linking)
VI  - 9
IP  - 1
DP  - 2022 Oct 11
TI  - Comparison of emergency surgical cricothyroidotomy and percutaneous 
      cricothyroidotomy by experienced airway providers in an obese, in vivo porcine 
      hemorrhage airway model.
PG  - 57
LID - 10.1186/s40779-022-00418-8 [doi]
LID - 57
AB  - 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 (SaO(2)) were 74.7 (IQR 46.6-84.2) % and 7.9 (IQR 4.1-15.6) % 
      (P = 0.0167), pO(2) 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.
CI  - (c) 2022. The Author(s).
FAU - Karlsson, Tomas
AU  - Karlsson T
AUID- ORCID: 0000-0002-0894-7288
AD  - Department of Clinical Science and Education, Section of Anesthesiology and 
      Intensive Care, Karolinska Institutet, 11883, Stockholm, Sweden. 
      tomas.karlsson@ki.se.
FAU - Brannstrom, Andreas
AU  - Brannstrom A
AD  - Department of Neuroscience, Karolinska Institutet, 17177, Stockholm, Sweden.
FAU - Gellerfors, Mikael
AU  - Gellerfors M
AD  - Department of Physiology and Pharmacology, Section of Anesthesiology and 
      Intensive Care, Karolinska Institutet, 11883, Stockholm, Sweden.
AD  - Department of Perioperative Medicine and Intensive Care, Karolinska University 
      Hospital, 17177, Stockholm, Sweden.
AD  - Swedish Air Ambulance (SLA), 79291, Mora, Sweden.
AD  - Rapid Response Cars, 18233, Stockholm, Sweden.
FAU - Gustavsson, Jenny
AU  - Gustavsson J
AD  - Department of Neuroscience, Karolinska Institutet, 17177, Stockholm, Sweden.
FAU - Gunther, Mattias
AU  - Gunther M
AD  - Department of Clinical Science and Education, Section of Anesthesiology and 
      Intensive Care, Karolinska Institutet, 11883, Stockholm, Sweden.
AD  - Department of Neuroscience, Karolinska Institutet, 17177, Stockholm, Sweden.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20221011
PL  - England
TA  - Mil Med Res
JT  - Military Medical Research
JID - 101643181
SB  - IM
MH  - *Airway Management/methods
MH  - Animals
MH  - *Cricoid Cartilage/surgery
MH  - Hemorrhage/surgery
MH  - Neck/surgery
MH  - Obesity/complications/surgery
MH  - Swine
PMC - PMC9552401
OTO - NOTNLM
OT  - Emergency front-of-neck airway
OT  - Percutaneous cricothyroidotomy
OT  - Porcine model
OT  - Surgical cricothyroidotomy
OT  - cannot oxygenate" (CICO)
OT  - "Cannot intubate
COIS- The authors declare no conflicts of interest.
EDAT- 2022/10/11 06:00
MHDA- 2022/10/13 06:00
PMCR- 2022/10/11
CRDT- 2022/10/10 23:45
PHST- 2022/04/15 00:00 [received]
PHST- 2022/09/20 00:00 [accepted]
PHST- 2022/10/10 23:45 [entrez]
PHST- 2022/10/11 06:00 [pubmed]
PHST- 2022/10/13 06:00 [medline]
PHST- 2022/10/11 00:00 [pmc-release]
AID - 10.1186/s40779-022-00418-8 [pii]
AID - 418 [pii]
AID - 10.1186/s40779-022-00418-8 [doi]
PST - epublish
SO  - Mil Med Res. 2022 Oct 11;9(1):57. doi: 10.1186/s40779-022-00418-8.