Needle, knife, or device – which choice in an airway crisis?

Excerpt

Emergency cricothyroidotomy is a life saving intervention included as the final step in most guidelines addressing the management of the emergency airway [1, 2]. The procedure must performed quickly and effectively to prevent death or hypoxic brain injury. Despite this a number of alternative approaches are recommended. Cricothyroidotomy can be performed using a needle or surgical approach, or with one of a large number of commercially available kits. Langvad and co-workers are to be congratulated on a comprehensive and systematic review of this controversial topic recently published in this journal [3]. The authors compared nine different combinations of cricothyroidotomy technique to summarise the available evidence. However, as is often the case in emergency medicine, systematic review of low-grade evidence does not necessarily equip the emergency physician with clear direction when faced with the emergency patient. The authors recognise that, given the considerable heterogeneity and poor quality of the studies, it was impossible to draw meaningful conclusions. No technique was demonstrated to be superior to the others. This conclusion does not mean that all techniques have similar success rates and complications, but that a limited amount of flawed evidence makes interpretation impossible. …