Evidence Is Important: Safety Considerations for Emergency Catheter Cricothyroidotomy

I t is an unarguable truth that providing appropriate training and equipment leads to improved outcomes in emergencies. Unfortunately, all too often the training and equipment are suboptimal and designed without sufficient attention to current evidence or an appreciation of the context of the emergency. Perhaps the starkest of these examples is in the provision of equipment and training for performance of the emergency surgical airway. A large, nationwide, year-long audit in the United Kingdom has shown that success rates for emergency cricothyroidotomy are highly variable. Singled out for particular criticism has been the catheter or “needle” method of accessing the airway and this is likely to be almost solely due to a lack of appropriate equipment and training. This commentary will outline the elements of safe practice of catheter cricothyroidotomy based on evidence from clinical and animal studies. The equipment, technique, and potential complications will be reviewed. The provision of oxygen via a catheter placed through the front of the neck into the trachea was first described by Jacoby and colleagues some 60 years ago. Although an inherently risky technique, in the past decade the technique has been scrutinized and refined based on data from elective head and neck surgery, animal, and mannequin-based simulation studies such that complication rates are now significantly lower. Catheter cricothyroidotomy provides some advantages over scalpel techniques in terms of lower psychological barriers to perform them and the ability to proceed to other more aggressive techniques should they fail. In the hands of appropriately trained practitioners it is likely that failure rates of emergency scalpel and catheter techniques for airway access are similar.