Advertisement

The Bougie-Aided Cricothyrotomy

      Surgical cricothyroidotomy is considered a critical skill in emergency airway management, though it is rarely used and fraught with complications. A variety of approaches are taught, including both the standard and rapid four-step techniques. We report a case in which an air medical crew used a gum-elastic bougie (endotracheal tube introducer), a common device in many airway kits, to facilitate surgical cricothyroidotomy in a 58-year-old patient with a pharyngeal mass, respiratory failure, and failed rapid sequence induction. We believe this technique may decrease the time until ventilation, minimize complications compared with other cricothyroidotomy techniques, and allow insertion of a larger-diameter endotracheal tube compared with other techniques.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Air Medical Journal
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • DeLaurier GA
        • Hawkins ML
        • Treat RC
        • Mansberger AR
        Acute airway management: Role of cricothyroidotomy.
        Am Surg. 1990; 56: 12-15
        • Spaite DW
        • Joseph M
        Prehospital cricothyrotomy: An investigation of indications, technique, complications, and patient outcome.
        Ann Emerg Med. 1990; 3: 279-285
        • Salvino CK
        • Dries D
        • Gamelli R
        • Murphy M
        • Marshall W
        Emergency cricothyroidotomy in trauma victims.
        J Trauma. 1993; 34: 503-505
        • Esses BA
        • Jafek BW
        Cricothyroidotomy: A decade of experience in Denver.
        Ann Otol Rhinol Laryngol. 1987; 96: 519-524
        • Erlandson MJ
        • Clinton JE
        • Ruiz E
        • Cohen J
        Cricothyrotomy in the emergency department revisited.
        J Emerg Med. 1989; 7: 115-118
        • Hawkins ML
        • Shapiro MB
        • Cue JI
        • Wiggins SS
        Emergency cricothyrotomy: A reassessment.
        Am Surg. 1995; 61: 52-55
        • McGill J
        • Clinton JE
        • Ruiz E
        Cricothyrotomy in the emergency department.
        Ann Emerg Med. 1982; 11: 361-364
        • Boyle MF
        • Hatton D
        • Sheets C
        Surgical cricothyrotomy performed by air ambulance flight nurses: A 5-year experience.
        J Emerg Med. 1993; 11: 41-45
        • Iserson KV
        • Sanders AB
        • Kaback K
        Difficult intubations: Aids and alternatives.
        Am Family Physician. 1985; 31: 99-112
        • Slobodkin D
        • Topliff S
        • Raife JH
        Retrograde intubation of the pharynx: An unusual complication of emergency cricothyrotomy.
        Ann Emerg Med. 1992; 21: 220-222
        • Benumof JL
        Management of the difficult adult airway.
        Anesthesiology. 1991; 75: 1087-1110
        • Johnson DR
        • Dunlap A
        • McFeeley P
        • Gaffney J
        • Busick B
        Cricothyrotomy performed by prehospital personnel: A comparison of two techniques in a human cadaver model.
        Am J Emerg Med. 1993; 11: 207-209
        • McIntosh SE
        • Swanson ER
        • Barton ED
        Cricothyrotomy in air medical transport.
        J Trauma. 2008; 64: 1543-1547
        • Bair AE
        • Panacek EA
        • Wisner DH
        • Bales R
        • Sakles JC
        Cricothyrotomy: A 5-year experience at one institution.
        J Emerg Med. 2003; 24: 151-156
        • Slobodkin D
        • Topliff S
        • Raife JH
        Retrograde intubation of the pharynx: An unusual complication of emergency cricothyrotomy.
        Ann Emerg Med. 1992; 21: 220-222
        • Walls RM
        Cricothyroidotomy.
        Emerg Med Clin North Am. 1988; 6: 725-736
        • Narrod JA
        • Moore EE
        • Rosen P
        Emergency cricothyrostomy: Technique and anatomical considerations.
        J Emerg Med. 1985; 2: 443-446
        • Dover K
        • Howdieshell TR
        • Colborn GL
        The dimensions and vascular anatomy of the cricothyroid membrane: relevance to emergent surgical airway access.
        Clin Anat. 1996; 19: 291-295
        • Brofeldt BT
        • Panacek EA
        • Richards JR
        An easy cricothyrotomy approach: The rapid four-step technique.
        Acad Emerg Med. 1996; 3: 1060-1063
        • Davis DP
        • Bramwell KJ
        • Hamilton RS
        • Chan TC
        • Vilke GM
        Safety and efficacy of the Rapid Four-Step Technique for cricothyrotomy using a Bair Claw.
        J Emerg Med. 2000; 19: 125-129
        • Holmes JF
        • Panacek EA
        • Sakles JC
        • Brofeldt BT
        Comparison of 2 cricothyrotomy techniques: Standard method versus rapid 4-step technique.
        Ann Emerg Med. 1998; 32: 442-446
        • Bair AE
        • Sakles JC
        A comparison of a novel cricothyrotomy device with standard surgical technique.
        Acad Emerg Med. 1997; 4 ([abstract].): 488
        • Davis DP
        • Bramwell KJ
        • Vilke GM
        • Cardall TY
        • Yoshida E
        • Rosen P
        Cricothyrotomy technique: Standard versus the rapid four-step technique.
        J Emerg Med. 1999; 17: 17-21
        • Griggs WM
        Cricothyrotomy concerns.
        Acad Emerg Med. 1997; 4 ([letter].): 1006-1007
        • MacIntyre A
        • Markarian MK
        • Carrison D
        • Coates J
        • Kuhls D
        • Fildes JJ
        Three-step emergency cricothryoidotomy.
        Mil Med. 2007; 172: 1228-1230
        • Smith MD
        • Katrinchak J
        Use of a gum elastic bougie during surgical crichothyrotomy.
        Am J Emerg Med. 2008; 26: 738.e1
        • Difficult Airway Society
        Difficult Airway Society equipment list: Recommended equipment for management of unanticipated difficult intubation.
        (Accessed July 2005.)
        • Levitan RM
        The airway*cam guide to intubation and practical emergency airway management. AirwayCam Technologies, Inc., Wayne, PA2004
        • Nocera A
        A flexible solution for emergency intubation difficulties.
        Ann Emerg Med. 1996; 27: 665-667
        • Jabre P
        • Combes X
        • Leroux B
        • Aaron E
        • Auger H
        • Margenet A
        Use of gum elastic bougie for prehospital difficult intubation.
        Am J Emerg Med. 2005; 23: 552-555
        • McGill JW
        • Vogel EC
        • Rodgerson JD
        Use of the gum elastic bougie as an adjunct for orotracheal intubation in the emergency department [Abstract].
        Acad Emerg Med. 2000; 7: 526
        • Dogra S
        • Falconer R
        • Latto IP
        Successful difficult intubation: Tracheal tube placement over a gum-elastic bougie.
        Anaesthesia. 1990; 45: 774-776
        • Gataure PS
        • Vaughan RS
        • Latto IP
        Simulated difficult intubation: comparison of the gum elastic bougie and the stylet.
        Anaesthesia. 1996; 51: 935-938
        • Kovacs G
        • Law JA
        • McCrossin C
        • Vu M
        • Leblanc D
        • Gao J
        A comparison of a fiberoptic stylet and a bougie as adjuncts to direct laryngoscopy in a manikin-simulated difficult airway.
        Ann Emerg Med. 2007; 50: 676-685