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2 results

  • The introduction of emergency cricothyroidotomy simulation training in Zimbabwe contributed to the saving of two lives

  • M B Avnstorp, P V F Jensen, T Dzongodza, N Matinhira, C Chidziva, J Melchiors, C Von Buchwald
  • Journal:
    The Journal of Laryngology & Otology / Volume 130 / Issue 10 / October 2016
    Published online by Cambridge University Press:
    09 September 2016, pp. 923-927
    Print publication:
    October 2016
  • Background:

    In developing countries with limited access to ENT services, performing emergency cricothyroidotomy in patients with upper airway obstruction may be a life-saving last resort. An established Danish–Zimbabwean collaboration of otorhinolaryngologists enrolled Zimbabwean doctors into a video-guided simulation training programme on emergency cricothyroidotomy. This paper presents the positive effect of this training, illustrated by two case reports.

    Case reports:

    A 56-year-old female presented with upper airway obstruction due to a rapidly progressing infectious swelling of the head and neck progressing to cardiac arrest. Cardiopulmonary resuscitation was initiated and a secure surgical airway was established via an emergency cricothyroidotomy, saving the patient. A 70-year-old male presented with upper airway obstruction secondary to intubation for an elective procedure. When extubated, the patient exhibited severe stridor followed by respiratory arrest. Re-intubation attempts were unsuccessful and emergency cricothyroidotomy was performed to secure the airway, preserving the life of the patient.

    Conclusion:

    Emergency cricothyroidotomy training should be considered for all surgeons, anaesthetists and, eventually, emergency and recovery room personnel in developing countries. A video-guided simulation training programme on emergency cricothyroidotomy in Zimbabwe proved its value in this regard.

  • Chapter 27 - Thoracic anaesthesia

  • from Section 3 - Specialties
  • Edited by Ian Calder, Adrian Pearce
  • Book:
    Core Topics in Airway Management
    Published online:
    10 January 2011
    Print publication:
    16 December 2010, pp 255-261

  • Summary

    Loss of the airway is quite apparent once oxygen saturations begin to fall but identifying it before this happens gives more time for a definitive diagnosis to be made and for the correct course of action to be implemented. It is obviously preferable to maintain ventilation throughout a general anaesthetic rather than have to rescue a lost airway. An emergency situation only exists when all three routine methods of oxygenation (facemask, laryngeal mask and tracheal intubation) have failed. The cricothyroid membrane is the preferred site for emergency access to the trachea for oxygenation. There are three types of cricothyroidotomy: small cannula devices, large bore cannula devices, and surgical cricothyroidotomy. Accepting the diagnosis of a lost airway is a difficult mental process. The only thing that distinguishes the lost airway from other cases is that the anaesthetist's usual armamentarium of techniques does not restore ventilation.