Cricothyrotomy Is Faster Than Tracheostomy for Emergency Front-of-Neck Airway Access in Dogs.

Sureiyan Hardjo,Catriona Croton,Solomon Woldeyohannes,Mark David Haworth,Sarah Leonie Purcell

doi:10.3389/fvets.2020.593687

Sureiyan Hardjo, Catriona Croton + Show 3 more

Open Access

https://doi.org/10.3389/fvets.2020.593687

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Abstract

Objectives: In novice final year veterinary students, we sought to: (1) compare the procedure time between a novel cricothyrotomy (CTT) technique and an abbreviated tracheostomy (TT) technique in canine cadavers, (2) assess the success rate of each procedure, (3) assess the complication rate of each procedure via a damage score, (4) evaluate the technical difficulty of each procedure and (5) determine the preferred procedure of study participants for emergency front-of-neck access.Materials and Methods: A prospective, cross-over, block randomised trial was performed, where veterinary students completed CTT and TT procedures on cadaver dogs. Eight students were recruited and performed 32 procedures on 16 dogs. A generalised estimating equation approach to modelling the procedure times was used.Results: The procedure time was significantly faster for the CTT than the TT technique, on average (p < 0.001). The mean time taken to complete the CTT technique was 49.6 s (95% CI: 29.5–69.6) faster on average, with a mean CTT time of less than half that of the TT. When taking into account the attempt number, the procedure time for a CTT was 66.4 s (95% CI: 38.9–93.9) faster than TT for the first attempt, and for the second attempt, this was 32.7 s (95% CI: 15.2–50.2) faster, on average. The success rate for both procedures was 100% and there was no difference detected in the damage or difficulty scores (P = 0.13 and 0.08, respectively). Seven of eight participants preferred the CTT.Clinical Significance: CTT warrants consideration as the primary option for emergency front-of-neck airway access for dogs.

Highlights

An upper airway obstruction not responsive to conventional oxygen supplementation or airway management is termed a “cannot intubate, cannot oxygenate” (CICO) event [1]
The gender imbalance was due to sourcing cadavers from ovariohysterectomy and female reproduction teaching
The results of this study found that the bougie assisted surgical CTT using the method as described by Hardjo et al [14] was significantly faster than a slash TT in canine cadavers on the first attempt at an airway surgery by veterinary students

Summary

Introduction

An upper airway obstruction not responsive to conventional oxygen supplementation or airway management is termed a “cannot intubate, cannot oxygenate” (CICO) event [1]. Known as emergency front-of-neck airway access (eFONA) is indicated to provide oxygen as soon as possible [1] Such scenarios are rare in veterinary medicine and to the authors’ knowledge, Cricothyrotomy vs Tracheostomy in Dogs there are no current publications detailing clinical cases of eFONA in small animals. There is little mention of the surgical tube cricothyrotomy (CTT) in the veterinary literature, yet this is the current eFONA standard in the 2015 Difficult Airway Society (DAS) guidelines in human medicine [1]. This procedure involves a surgical incision into the cricothyroid space and the insertion of an endotracheal tube. The CTT is rapid, easy to perform, and has minimal complications in human medicine due to the superficial anatomical landmarks targeted in the procedure [11,12,13]

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