Complications of cricothyroidotomy versus tracheostomy in emergency surgical airway management: a systematic review

Fabricio Batistella Zasso,Khrystyna Losyeva,Jaya Tanwani,Naveed Siddiqui,Michelle Ryu,Kong Eric You-Ten

doi:10.1186/s12871-020-01135-2

Fabricio Batistella Zasso, Khrystyna Losyeva + Show 4 more

Open Access

https://doi.org/10.1186/s12871-020-01135-2

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Abstract

BackgroundAirway 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.MethodsThis 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).ResultsWe 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].ConclusionsOur 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.

Highlights

Airway guidelines recommend an emergency surgical airway as a potential life-saving treatment in a “Can’t Intubate, Can’t Oxygenate” (CICO) situation
Duplicate records were removed in EndNote X8 citation management software
21 articles were included in the systematic review (Fig. 1 – Flow chart)

Summary

Introduction

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 objective of this systematic review is to analyze complications following cricothyroidotomy and tracheostomy in airway emergencies. Failed airway management can lead to a “Can’t Intubate Can’t Oxygenate” (CICO) situation, which is defined by failed attempts to deliver oxygen to the patient by face-mask ventilation, tracheal intubation, and placement of a supraglottic airway [1,2,3]. An unanticipated difficult airway can lead to a CICO crisis. When this feared situation happens, airway guidelines recommend that an emergency surgical airway should be performed either through a cricothyroidotomy or tracheostomy [3, 5]

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