Surgical Airway Management
Critical Care / Resuscitation, Respiratory
Context
- Once the decision to perform a surgical airway has been made it is essential that the procedure be performed in a deliberate and efficient manner.
- It is our recommendation and that of other airway practitioners and societies that the “bougie cric” or bougie cricothyrotomy technique is the standard method of surgical airway establishment in the resuscitative emergency airway management
- For details of performing the procedure see procedural video: cricothyrotomy.
Management
Procedure:
- Stabilization of the thyroid cartilage,
- Confirmation of the cricothyroid membrane,
- A deep vertical incision over above and below the cricothyroid membrane,
- Penetration of the cricothyroid membrane (and enlargement) and
- Passage caudally of the bougie
- Insertion of the ET tube over the bougie
- Cuff inflation and confirmation of tube placement as with any tracheal intubation with endtidal-CO2 reading and assessment of oxygenation.
- Similar videos exist online, but the procedure must be practised and standardized and the associated equipment must be readily available and optimally packaged and ready for use in the emergency department.
Equipment:
- a bougie,
- a large blade (ie. #10, 20, 21) and
- a number 6.0 endotracheal tube.
- Always make sure your bougie fits your tube prior to the procedure.
Quality Of Evidence?
High
We are highly confident that the true effect lies close to that of the estimate of the effect. There is a wide range of studies included in the analyses with no major limitations, there is little variation between studies, and the summary estimate has a narrow confidence interval.
Moderate
We consider that the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. There are only a few studies and some have limitations but not major flaws, there are some variations between studies, or the confidence interval of the summary estimate is wide.
Low
When the true effect may be substantially different from the estimate of the effect. The studies have major flaws, there is important variations between studies, of the confidence interval of the summary estimate is very wide.
Justification
Case series and consensus opinion by airway experts.
Related Information
OTHER RELEVANT INFORMATION
AIME Airway procedural videos: http://aimeairway.ca/video-39-s
Scott Weingart. EMCrit Podcast 131 – Cricothyrotomy – Cut to Air: Emergency Surgical Airway. EMCrit Blog. Published on August 26, 2014. Accessed on July 25th 2017. Available at [https://emcrit.org/emcrit/surgical-airway/].
Including:
https://emcrit.org/emcrit/wearable-cric-trainer/,
https://emcrit.org/emcrit/surgical-airway/,
https://emcrit.org/emcrit/bougie-aided-cric/Airway Management in Emergencies – Open-access online textbook from www.aimeairway.ca.
Relevant Resources
RESOURCE AUTHOR(S)
DISCLAIMER
The purpose of this document is to provide health care professionals with key facts and recommendations for the diagnosis and treatment of patients in the emergency department. This summary was produced by Emergency Care BC (formerly the BC Emergency Medicine Network) and uses the best available knowledge at the time of publication. However, healthcare professionals should continue to use their own judgment and take into consideration context, resources and other relevant factors. Emergency Care BC is not liable for any damages, claims, liabilities, costs or obligations arising from the use of this document including loss or damages arising from any claims made by a third party. Emergency Care BC also assumes no responsibility or liability for changes made to this document without its consent.
Last Updated Dec 14, 2018
Visit our website at https://emergencycarebc.ca
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