Spies Fabian, Burmester Alexander, Schälte Gereon
Klinik für Anästhesiologie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland.
Klinik für Anästhesie, Intensiv- und Notfallmedizin, Bundeswehrkrankenhaus Hamburg, Lesserstraße 180, 22049, Hamburg, Deutschland.
Anaesthesiologie. 2023 May;72(5):369-380. doi: 10.1007/s00101-023-01279-z. Epub 2023 May 8.
Cricothyrotomy represents the final approach to secure the airway, in the course of which less invasive measures have failed. It can also primarily be carried out to establish a secure airway. This is essential to protect the patient from a significant hypoxia. This is a cannot ventilate-cannot oxygenate (CVCO) situation, which presumably all colleagues in emergency intensive care medicine and anesthesia have already been confronted with. Evidence-based algorithms for the management of a difficult airway and CVCO have been established. If oxygenation using an endotracheal tube, an extraglottic airway device or bag-valve mask ventilation all fail, the airway must be surgically secured, i.e. using cricothyrotomy. The prevalence of the CVCO situation in a prehospital setting is ca. 1%. No valid prospective randomized in vivo studies have been carried with respect to the question of the best method.
环甲膜切开术是在其他侵入性较小的措施失败后确保气道通畅的最终手段。它也可主要用于建立安全气道。这对于保护患者免受严重缺氧至关重要。这是一种无法通气-无法给氧(CVCO)的情况,想必急诊重症医学和麻醉领域的所有同仁都已经遇到过。针对困难气道和CVCO的管理,已建立了循证算法。如果使用气管内导管、声门外气道装置或袋阀面罩通气进行给氧均失败,则必须通过手术确保气道通畅,即采用环甲膜切开术。在院前环境中,CVCO情况的发生率约为1%。关于最佳方法的问题,尚未进行有效的前瞻性随机体内研究。