Complications of cricothyroidotomy versus tracheostomy in emergency surgical airway management: a systematic review
Abstract Background Airway guidelines recommend an emergency surgical airway as a potential life-saving treatment in a “Can’t Intubate, Can’t Oxygenate” (CICO) situation. Surgical airways can be achieved either through a cricothyroidotomy or tracheostomy. The current literature has limited data rega...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2020-08-01
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| Series: | BMC Anesthesiology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12871-020-01135-2 |
| _version_ | 1818334969964003328 |
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| author | Fabricio Batistella Zasso Kong Eric You-Ten Michelle Ryu Khrystyna Losyeva Jaya Tanwani Naveed Siddiqui |
| author_facet | Fabricio Batistella Zasso Kong Eric You-Ten Michelle Ryu Khrystyna Losyeva Jaya Tanwani Naveed Siddiqui |
| author_sort | Fabricio Batistella Zasso |
| collection | DOAJ |
| description | Abstract Background Airway guidelines recommend an emergency surgical airway as a potential life-saving treatment in a “Can’t Intubate, Can’t Oxygenate” (CICO) situation. Surgical airways can be achieved either through a cricothyroidotomy or tracheostomy. The current literature has limited data regarding complications of cricothyroidotomy and tracheostomy in an emergency situation. The objective of this systematic review is to analyze complications following cricothyroidotomy and tracheostomy in airway emergencies. Methods This synthesis of literature was exempt from ethics approval. Eight databases were searched from inception to October 2018, using a comprehensive search strategy. Studies were included if they were randomized controlled trials or observational studies reporting complications following emergency surgical airway. Complications were classified as minor (evolving to spontaneous remission or not requiring intervention or not persisting chronically), major (requiring intervention or persisting chronically), early (from the start of the procedure up to 7 days) and late (beyond 7 days of the procedure). Results We retrieved 2659 references from our search criteria. Following the removal of duplicates, title and abstract review, 33 articles were selected for full-text reading. Twenty-one articles were finally included in the systematic review. We found no differences in minor, major or early complications between the two techniques. However, late complications were significantly more frequent in the tracheostomy group [OR (95% CI) 0.21 (0.20–0.22), p < 0.0001]. Conclusions Our results demonstrate that cricothyroidotomies performed in emergent situations resulted in fewer late complications than tracheostomies. This finding supports the recommendations from the latest Difficult Airway Society (DAS) guidelines regarding using cricothyroidotomy as the technique of choice for emergency surgical airway. However, emergency cricothyroidotomies should be converted to tracheostomies in a timely fashion as there is insufficient evidence to suggest that emergency cricothyrotomies are long term airways. |
| first_indexed | 2024-12-13T14:15:59Z |
| format | Article |
| id | doaj.art-874ec2d9b6eb427a9b188630a458dc62 |
| institution | Directory Open Access Journal |
| issn | 1471-2253 |
| language | English |
| last_indexed | 2024-12-13T14:15:59Z |
| publishDate | 2020-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Anesthesiology |
| spelling | doaj.art-874ec2d9b6eb427a9b188630a458dc622022-12-21T23:42:17ZengBMCBMC Anesthesiology1471-22532020-08-0120111010.1186/s12871-020-01135-2Complications of cricothyroidotomy versus tracheostomy in emergency surgical airway management: a systematic reviewFabricio Batistella Zasso0Kong Eric You-Ten1Michelle Ryu2Khrystyna Losyeva3Jaya Tanwani4Naveed Siddiqui5MD, Department of Anaesthesia, Mount Sinai Hospital, University of TorontoMD, Department of Anaesthesia, Mount Sinai Hospital, University of TorontoMLIS, Information Specialist, Sidney Liswood Health Science Library, Sinai Health System, University of TorontoSummer Research Student, Mount Sinai Hospital, University of TorontoMedical Student, Faculty of Medicine, University of TorontoMD, Department of Anaesthesia, Mount Sinai Hospital, University of TorontoAbstract Background Airway guidelines recommend an emergency surgical airway as a potential life-saving treatment in a “Can’t Intubate, Can’t Oxygenate” (CICO) situation. Surgical airways can be achieved either through a cricothyroidotomy or tracheostomy. The current literature has limited data regarding complications of cricothyroidotomy and tracheostomy in an emergency situation. The objective of this systematic review is to analyze complications following cricothyroidotomy and tracheostomy in airway emergencies. Methods This synthesis of literature was exempt from ethics approval. Eight databases were searched from inception to October 2018, using a comprehensive search strategy. Studies were included if they were randomized controlled trials or observational studies reporting complications following emergency surgical airway. Complications were classified as minor (evolving to spontaneous remission or not requiring intervention or not persisting chronically), major (requiring intervention or persisting chronically), early (from the start of the procedure up to 7 days) and late (beyond 7 days of the procedure). Results We retrieved 2659 references from our search criteria. Following the removal of duplicates, title and abstract review, 33 articles were selected for full-text reading. Twenty-one articles were finally included in the systematic review. We found no differences in minor, major or early complications between the two techniques. However, late complications were significantly more frequent in the tracheostomy group [OR (95% CI) 0.21 (0.20–0.22), p < 0.0001]. Conclusions Our results demonstrate that cricothyroidotomies performed in emergent situations resulted in fewer late complications than tracheostomies. This finding supports the recommendations from the latest Difficult Airway Society (DAS) guidelines regarding using cricothyroidotomy as the technique of choice for emergency surgical airway. However, emergency cricothyroidotomies should be converted to tracheostomies in a timely fashion as there is insufficient evidence to suggest that emergency cricothyrotomies are long term airways.http://link.springer.com/article/10.1186/s12871-020-01135-2CricothyroidotomyTracheostomyComplicationsEmergency surgical airwaySystematic review |
| spellingShingle | Fabricio Batistella Zasso Kong Eric You-Ten Michelle Ryu Khrystyna Losyeva Jaya Tanwani Naveed Siddiqui Complications of cricothyroidotomy versus tracheostomy in emergency surgical airway management: a systematic review BMC Anesthesiology Cricothyroidotomy Tracheostomy Complications Emergency surgical airway Systematic review |
| title | Complications of cricothyroidotomy versus tracheostomy in emergency surgical airway management: a systematic review |
| title_full | Complications of cricothyroidotomy versus tracheostomy in emergency surgical airway management: a systematic review |
| title_fullStr | Complications of cricothyroidotomy versus tracheostomy in emergency surgical airway management: a systematic review |
| title_full_unstemmed | Complications of cricothyroidotomy versus tracheostomy in emergency surgical airway management: a systematic review |
| title_short | Complications of cricothyroidotomy versus tracheostomy in emergency surgical airway management: a systematic review |
| title_sort | complications of cricothyroidotomy versus tracheostomy in emergency surgical airway management a systematic review |
| topic | Cricothyroidotomy Tracheostomy Complications Emergency surgical airway Systematic review |
| url | http://link.springer.com/article/10.1186/s12871-020-01135-2 |
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