Timmermann et al. Need to consider human factors when determining first-line technique foremergency front-of-neck access. Br J Anaesth. 2016 May 20

Dr. Timmermann, Dr. Chrimes and Dr. Hagberg responded to the recently published 2015 Guidelines of the Difficult Airway Society (DAS), which endorse scalpel cricothyroidotomy as the sole method for emergency front-of-neck access:
“This sole recommendation of a scalpel technique may increase the psychological barriers to successful achievement of front-of-neck access in an appropriate time frame when a CICO situation occurs. Training in both (scalpel-based and cannula-based) techniques remains warranted, and the option to use either technique should continue to be advocated.”
In addition to airway management techniques, they advised on ventilation techniques to be used after obtaining front-of-neck access. They suggest three commercial devices: two “passive expiration” devices or the “active expiration” device Ventrain:
“These provide, in contrast to a jet ventilator, an affordable, simple mechanism for oxygen insufflation via a cannula that can be connected to a standard oxygen outlet and allows for passive or even active expiration via the cannula between breaths. Techniques have been developed for use of these devices, intended to minimize the risk of complications from volutrauma and barotrauma, even when the upper airway is completely obstructed.”
This editorial emphasizes the multiple options for saving a patient’s life in an emergency CICO situation regarding front of neck access methods as well as the associated ventilation methods.

 

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