Correspondence An easy-to-use and ready-made “cricothyrotomy kit”
83 other's best (Figure). Therefore, we have recommended that “5 to 5” is the novel and easy-to-remember combination of needle cricothyrotomy kit in emergence situation.
To the Editor: Needle cricothyrotomy has been the traditional end point of life-saving procedure to the failed emergency difficult airway. It provides the simplest, fastest, and safest access for temporary ventilation [1]. Therefore, cricothyrotomy device such as the Rusch QuickTrach Cricothyrotomy Kit has been created and widely used as an optical emergency airway tool in the presence of acute upper airway obstruction if intubation or tracheotomy is impossible (eg, glottis edema, foreign body, and carcinoma of the larynx) [2]. However, the drawback of using this kit involves the requirement of well-trained medical professional and relatively time consuming in the “step-by-step” cricothyrotomy process especially in infants and young children. We would like to describe a flexible, readily available, and easy to set up “cricothyrotomy kit,” which had successfully rescued an unexpected pediatric difficult airway crisis in our department. This patient was failed airway after routine management approaches, a 16G cannula over needle was immediately inserted through the skin into the trachea via the cricothyroid membrane and confirmed the correct tracheal entry by aspirating air through a 5-mL syringe, and, then, a 5.0# inflated tracheal tube was quickly inserted into the syringe barrel, after the plunger was taken out. The closed ventilator circuitry was set up by connecting the tube to the ventilator, and intermittent jet of oxygen was ventilated through the cannula to gain enough time for emergence cricothyroidotomy. In this case, the syringe and tracheal tube combination was used, as the connection between the cannula and ventilation system has the following advantages. Firstly, this “cricothyrotomy kit” was consisted of intravenous needle cannula, which was thought to be an easy-to-use and ready-made kit, for everything it involved could be ready and available in the operation theater. And more important, the novel of this kit was that we used a long and flexible tracheal tube connected to the ventilator circuit instead of the comparatively short and rigid tracheal tube adapter reported in previous articles [3], which may decrease the chance of cricothyroidotomy catheter dislodgement [4]. Before we use this “cricothyrotomy kit”, the only thing you must do to prevent air leakage is to satisfy the following 2 requirements: (1) the inner diameter of syringe must be bigger than the outer diameter of the chosen endotracheal tube and (2) the inner diameter of syringe is slightly less than the inflated balloon diameter of the tube. By comparing the various sizes of the inner diameter of syringes barrel and the outer diameter of tubes, it can be easily concluded that tube 5# is able to meet the most of syringes' standard, and the 5-mL syringe has as much as 6 different sizes of tube to be met with the standard. Perceiving the differences between brands as negligible, the combination between tube 5# and 5-mL syringe matches each
Kaizhi Lu, MD Jian Cui, MD Chao Zhang, MD Jiaolin Ning, MD Chunyong Yang, MD⁎ Department of Anesthesia, Southwest Hospital the Third Military Medical University Chongqing 400038, China ⁎Corresponding author. Department of Anesthesia Southwest Hospital, the Third Military Medical University Chongqing 400038, China E-mail address: [email protected]
http://dx.doi.org/10.1016/j.jclinane.2014.10.006
References [1] Leibovici D, Fredman B, Gofrit ON, Shemer J, Blumenfeld A, Shapira SC. Prehospital cricothyroidotomy by physicians. Am J Emerg Med 1997;15(1):91-3. [2] Fikkers BG, Van Vugt S, Van Der Hoeven JG, Van Den Hoogen FJA, Marres HAM. Emergency cricothyrotomy: a randomised crossover trial comparing the wire-guided and catheter-over-needle techniques. Anaesthesia 2004;59(10):1008-11. [3] Kofke WA, Horak J, Stiefel M, Pascual J. Viable oxygenation with cannula-over-needle cricothyrotomy for asphyxial airway occlusion. Br J Anaesth 2011;107(4):642-3. [4] Gaufbergm SV, Workman TP. New needle cricothyroidotomy setup. Am J Emerg Med 2004;22(1):37-9.
Figure The easy-to-use and ready-made “cricothyrotomy kit” contains one 5-mL syringe, 1 tracheal tube, and 1 14G cannula.
83 other's best (Figure). Therefore, we have recommended that “5 to 5” is the novel and easy-to-remember combination of needle cricothyrotomy kit in emergence situation.
To the Editor: Needle cricothyrotomy has been the traditional end point of life-saving procedure to the failed emergency difficult airway. It provides the simplest, fastest, and safest access for temporary ventilation [1]. Therefore, cricothyrotomy device such as the Rusch QuickTrach Cricothyrotomy Kit has been created and widely used as an optical emergency airway tool in the presence of acute upper airway obstruction if intubation or tracheotomy is impossible (eg, glottis edema, foreign body, and carcinoma of the larynx) [2]. However, the drawback of using this kit involves the requirement of well-trained medical professional and relatively time consuming in the “step-by-step” cricothyrotomy process especially in infants and young children. We would like to describe a flexible, readily available, and easy to set up “cricothyrotomy kit,” which had successfully rescued an unexpected pediatric difficult airway crisis in our department. This patient was failed airway after routine management approaches, a 16G cannula over needle was immediately inserted through the skin into the trachea via the cricothyroid membrane and confirmed the correct tracheal entry by aspirating air through a 5-mL syringe, and, then, a 5.0# inflated tracheal tube was quickly inserted into the syringe barrel, after the plunger was taken out. The closed ventilator circuitry was set up by connecting the tube to the ventilator, and intermittent jet of oxygen was ventilated through the cannula to gain enough time for emergence cricothyroidotomy. In this case, the syringe and tracheal tube combination was used, as the connection between the cannula and ventilation system has the following advantages. Firstly, this “cricothyrotomy kit” was consisted of intravenous needle cannula, which was thought to be an easy-to-use and ready-made kit, for everything it involved could be ready and available in the operation theater. And more important, the novel of this kit was that we used a long and flexible tracheal tube connected to the ventilator circuit instead of the comparatively short and rigid tracheal tube adapter reported in previous articles [3], which may decrease the chance of cricothyroidotomy catheter dislodgement [4]. Before we use this “cricothyrotomy kit”, the only thing you must do to prevent air leakage is to satisfy the following 2 requirements: (1) the inner diameter of syringe must be bigger than the outer diameter of the chosen endotracheal tube and (2) the inner diameter of syringe is slightly less than the inflated balloon diameter of the tube. By comparing the various sizes of the inner diameter of syringes barrel and the outer diameter of tubes, it can be easily concluded that tube 5# is able to meet the most of syringes' standard, and the 5-mL syringe has as much as 6 different sizes of tube to be met with the standard. Perceiving the differences between brands as negligible, the combination between tube 5# and 5-mL syringe matches each
Kaizhi Lu, MD Jian Cui, MD Chao Zhang, MD Jiaolin Ning, MD Chunyong Yang, MD⁎ Department of Anesthesia, Southwest Hospital the Third Military Medical University Chongqing 400038, China ⁎Corresponding author. Department of Anesthesia Southwest Hospital, the Third Military Medical University Chongqing 400038, China E-mail address: [email protected]
http://dx.doi.org/10.1016/j.jclinane.2014.10.006
References [1] Leibovici D, Fredman B, Gofrit ON, Shemer J, Blumenfeld A, Shapira SC. Prehospital cricothyroidotomy by physicians. Am J Emerg Med 1997;15(1):91-3. [2] Fikkers BG, Van Vugt S, Van Der Hoeven JG, Van Den Hoogen FJA, Marres HAM. Emergency cricothyrotomy: a randomised crossover trial comparing the wire-guided and catheter-over-needle techniques. Anaesthesia 2004;59(10):1008-11. [3] Kofke WA, Horak J, Stiefel M, Pascual J. Viable oxygenation with cannula-over-needle cricothyrotomy for asphyxial airway occlusion. Br J Anaesth 2011;107(4):642-3. [4] Gaufbergm SV, Workman TP. New needle cricothyroidotomy setup. Am J Emerg Med 2004;22(1):37-9.
Figure The easy-to-use and ready-made “cricothyrotomy kit” contains one 5-mL syringe, 1 tracheal tube, and 1 14G cannula.
