The (Un)common Cric- Incidence of Surgical Airway in Modern Medicine
Dec 14, 2023
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Exploring the rarity of surgical airway procedures in modern medicine and the importance of maintaining skills for such procedures. Reviewing the incidence of cricothyroidotomy in emergency medicine and the impact of technology on decreasing the need for this procedure.
The current incidence of surgical airways post-tracheal intubations ranges from 0.3% to 1.1%, showcasing the rare need for this procedure despite advancements in airway management technology.
Approximately half of cricothyroidotomy cases are trauma-related, with 14 patients in arrest during intubation, highlighting the critical and time-sensitive nature of airway management interventions.
Deep dives
Frequency of Cricothyroidotomy Incidence
The podcast delves into the evolving incidence of cricothyroidotomy, particularly in failed airway scenarios. Data from the American Journal of Emergency Medicine is discussed, indicating a current incidence of 0.3% to 1.1% for rescue airways post-tracheal intubations. A study within the NEAR dataset from 2016 to 2018 showcases that out of 17,720 intubation attempts, 49 necessitated surgical airways, equating to 2.8 cases per thousand or 0.28%. This illustrates the importance of maintaining readiness for rare procedures despite advancements in airway management technology.
Patient Profiles and Execution Factors
The podcast highlights the patient demographics and circumstances leading to cricothyroidotomy. Of the 49 cases requiring surgical airways, approximately half were trauma-related, while the rest were medical cases. Notably, 14 patients were in arrest during the intubation attempts, emphasizing the critical nature of timely airway management. The average number of attempts before resorting to cricothyroidotomy was 2, underscoring the importance of swift decision-making in airway interventions.
Significance of Skill Maintenance and Preparedness
The discussion culminates in emphasizing the necessity of maintaining proficiency in cricothyroidotomy despite its infrequent occurrence. Though advancements in medical training and technology have potentially reduced the need for surgical airways, a vigilant and skilled approach remains crucial. The podcast advocates for preparedness, underscoring that while modern practices may lower the incidence of such procedures, being proficient in rare interventions is paramount for emergency medicine providers.
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Exploring the Rarity of Surgical Airway Procedures in Modern Medicine
How often do we, as Emergency Medicine clinicians, have to do a cric? Is that number changing with time? We attempt to answer these questions with a review of some current literature.