Department of Anesthesiology and Pain Medicine, Mount Sinai Hospital-Sinai Health System, University of Toronto, 7-405, 600 University Avenue, Toronto, ON, M5G 1X5, Canada.
Department of Family Medicine-Emergency Medicine, Mount Sinai Hospital-Sinai Health System, University of Toronto, Toronto, ON, Canada.
CJEM. 2022 Dec;24(8):862-866. doi: 10.1007/s43678-022-00399-6. Epub 2022 Nov 8.
A large vertical incision is recommended when performing front-of-neck access in patients with impalpable neck landmarks during a cannot intubate-cannot oxygenate (CICO) scenario. We investigated the impact of ultrasonography on vertical incision size of a front-of-neck access on an ultrasound-compatible impalpable porcine larynx model.
Emergency medicine and anesthesia trainees were randomized to the Ultrasound (US, n = 21) and Non-Ultrasound (NUS, n = 21) groups. Within 1 week after a teaching session on airway ultrasound and Scalpel-Bougie-Tube (SBT) technique, participants were instructed to perform cricothyroidotomy on the model during a simulated cannot intubate-cannot oxygenate scenario. The primary outcome was a vertical size incision. Secondary outcomes were procedural completion time, horizontal size incision, tissue injury severity, and correct tube placement.
The ultrasound group performed a significantly smaller vertical incision [median (IQR), 35.0 (15, 40) vs 65.0 (52, 100) mm (95% CI) - 30.0 (- 55.1, - 4.9), p = 0.02] and took longer total time to complete the procedure [median (IQR), 200.5 (126, 267) vs 93.5 (71.0, 167.5) secs (95% CI) 91.0 (3.73, 178.3), p = 0.04]. Tissue injury severity and correct tube placement were similar between groups.
Ultrasound-guided identification of the cricothyroid membrane significantly reduced the recommended vertical incision size with similar success rates. However, there was an increased time when performing a Scalpel-Bougie-Tube cricothyroidotomy on an impalpable porcine larynx model by physicians in training. Ultrasonography should not be used in an emergency scenario of airway rescue. Its potential use to pre-mark the cricothyroid membrane should be considered in difficult airway management of impalpable neck.
在无法插管-无法给氧（CICO）情况下，对于颈前触诊标志不明显的患者，建议行颈前路入路时采用大的垂直切口。我们研究了超声检查对超声兼容的无法触诊猪喉模型前路入路垂直切口大小的影响。
急诊医学和麻醉学学员被随机分为超声（US）组（n=21）和非超声（NUS）组（n=21）。在气道超声和刀-探条-管（SBT）技术教学课程结束后 1 周内，参与者在模拟无法插管-无法给氧的情况下，指导他们在模型上进行环甲膜切开术。主要结局是垂直切口大小。次要结局是操作完成时间、水平切口大小、组织损伤严重程度和正确的管放置。
超声组行垂直切口明显较小[中位数（IQR），35.0（15.0，40.0）比 65.0（52.0，100.0）mm（95%CI）-30.0（-55.1，-4.9），p=0.02]，总操作时间也较长[中位数（IQR），200.5（126.0，267.0）比 93.5（71.0，167.5）secs（95%CI）91.0（3.73，178.3），p=0.04]。两组组织损伤严重程度和正确管放置相似。
超声引导识别环甲膜显著减小了推荐的垂直切口大小，且成功率相似。然而，在训练有素的医生对无法触诊的猪喉模型行刀-探条-管环甲膜切开术时，时间会增加。在气道急救情况下，不应使用超声。在无法触诊的颈部困难气道管理中，应考虑预先标记环甲膜。
