A comparison of scalpel-bougie-tube and Cric-Guide® in a simulated obese bleeding tissue model

TY - JOUR

T1 - A comparison of scalpel-bougie-tube and Cric-Guide® in a simulated obese bleeding tissue model

AU - Belford, Iain

AU - Wright, Kirsty

AU - Janeczko, Adam

AU - Crawley, Simon

AU - McLeod, Graeme

AU - Maini, Naveeta

N1 - Publisher Copyright: © AME Publishing Company.

PY - 2023/9/30

Y1 - 2023/9/30

N2 - Background: Difficult Airway Society (DAS) guidelines for the management of unanticipated difficult intubation recommends the scalpel-bougie-tube (SBT) technique for emergency front of neck access (eFONA). Additionally, they recommend an 8–10 cm midline vertical incision in the obese patient. A novel cricothyroidotomy introducer, the Cric-Guide® has been developed to facilitate eFONA. We sought to compare the time required to secure eFONA using the Cric-Guide® compared to the SBT in a tissue model simulating the obese bleeding neck. Methods: The model—a porcine trachea overlaid with pork belly infiltrated with 30 mL of stage blood. Twelve participants were given written and video instructions on the use of the Cric-Guide® and were allowed time to familiarise themselves with the equipment. Participants performed eFONA 8 times as per the DAS recommended technique for the obese patient, 4 using the red-sized Cric-Guide® and 4 using the traditional SBT technique. Results: The primary outcome was the time taken from first handling the scalpel to inflation of the endotracheal (ET) cuff within the trachea. Secondary outcomes included: number of passes to correctly insert the ET tube into the trachea per attempt; number of false passages created; degree of posterior tracheal wall damage; and ease of use of the Cric-Guide®. Posterior tracheal wall trauma was assessed and graded by a Consultant Head and Neck surgeon, on a scale of 0 (no damage)–3 (full thickness perforation). Ninety-six procedures were performed. Time to secure the airway was faster using the Cric-Guide® (58 vs. 72 s, P=0.047) but was associated with greater trauma {median [interquartile range (IQR); range]: 1 (0–2; 0–3) vs. 1 (0–1; 0–2), P=0.008}. Participant feedback was positive regarding the Cric-Guide® and its ease of use— 11 participants preferred it over SBT in potential future eFONA scenarios. Across the remaining outcome measures, Cric-Guide® was shown to be no different to SBT. Conclusions: Our work shows that the Cric-Guide® facilitates faster access to the simulated obese bleeding airway than SBT, but that it causes increased frequency of posterior tracheal wall damage. We recognise the need to perform further research on any modified techniques designed to limit this damage.

AB - Background: Difficult Airway Society (DAS) guidelines for the management of unanticipated difficult intubation recommends the scalpel-bougie-tube (SBT) technique for emergency front of neck access (eFONA). Additionally, they recommend an 8–10 cm midline vertical incision in the obese patient. A novel cricothyroidotomy introducer, the Cric-Guide® has been developed to facilitate eFONA. We sought to compare the time required to secure eFONA using the Cric-Guide® compared to the SBT in a tissue model simulating the obese bleeding neck. Methods: The model—a porcine trachea overlaid with pork belly infiltrated with 30 mL of stage blood. Twelve participants were given written and video instructions on the use of the Cric-Guide® and were allowed time to familiarise themselves with the equipment. Participants performed eFONA 8 times as per the DAS recommended technique for the obese patient, 4 using the red-sized Cric-Guide® and 4 using the traditional SBT technique. Results: The primary outcome was the time taken from first handling the scalpel to inflation of the endotracheal (ET) cuff within the trachea. Secondary outcomes included: number of passes to correctly insert the ET tube into the trachea per attempt; number of false passages created; degree of posterior tracheal wall damage; and ease of use of the Cric-Guide®. Posterior tracheal wall trauma was assessed and graded by a Consultant Head and Neck surgeon, on a scale of 0 (no damage)–3 (full thickness perforation). Ninety-six procedures were performed. Time to secure the airway was faster using the Cric-Guide® (58 vs. 72 s, P=0.047) but was associated with greater trauma {median [interquartile range (IQR); range]: 1 (0–2; 0–3) vs. 1 (0–1; 0–2), P=0.008}. Participant feedback was positive regarding the Cric-Guide® and its ease of use— 11 participants preferred it over SBT in potential future eFONA scenarios. Across the remaining outcome measures, Cric-Guide® was shown to be no different to SBT. Conclusions: Our work shows that the Cric-Guide® facilitates faster access to the simulated obese bleeding airway than SBT, but that it causes increased frequency of posterior tracheal wall damage. We recognise the need to perform further research on any modified techniques designed to limit this damage.

KW - Cricothyroidotomy

KW - difficult airway

KW - emergency front of neck access (eFONA)

UR - https://www.scopus.com/pages/publications/105004994436

U2 - 10.21037/joma-23-16

DO - 10.21037/joma-23-16

M3 - Article

AN - SCOPUS:105004994436

VL - 2

JO - Journal of Oral and Maxillofacial Anesthesia

JF - Journal of Oral and Maxillofacial Anesthesia

M1 - 23

ER -