Prehospital Cricothyrotomy: A Narrative Review of Technical, Educational, and Operational Considerations for Procedure Optimization

IF 1.2 4区 医学 Q3 EMERGENCY MEDICINE
Aaron J. Lacy MD , Michael J. Kim MD , James L. Li MD, M.Ed , Alexander Croft MD , Erin E. Kane MD, MHPE , Jason C. Wagner MD , Philip W. Walker MD , Christine M. Brent MD , Jeremy J. Brywczynski MD , Amanda C. Mathews MD , Brit Long MD , Alex Koyfman MD , Bridgette Svancarek MD
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引用次数: 0

Abstract

Background

Definitive airway management is a requisite skill in the prehospital setting, most often accomplished with either an endotracheal tube or supraglottic airway. When clinicians encounter a cannot oxygenate and cannot ventilate scenario, a patient's airway still must be secured. Prehospital cricothyrotomy is a high acuity, low frequency procedure used to secure the airway through the anterior neck. Patients who require cricothyrotomy often have significant comorbid conditions and mortality, and there can be a high rate of procedural complications. The ability to perform a cricothyrotomy is within the scope of practice for many prehospital clinicians and mastery of the procedure is crucial for patient outcomes. Despite this, initial training on the procedure is minimal, and paramedics report discomfort in their ability to perform the procedure.

Objective

Review and summarize the best available evidence relating to the performance of cricothyrotomies and propose technical, educational, and operational considerations to minimize complications and optimize success of prehospital cricothyrotomies.

Discussion

Technical considerations when performing cricothyrotomy in the prehospital setting can be used to mitigate airway misplacement, mainstem intubation, and hemorrhage. Educational consideration should include focus on a singular technique, use of established curriculum, spaced repetition with either simulation or mental practice, and a focus on intention training of when to perform the procedure. The preferred technique from the National Association of Emergency Medical Service (EMS) Physician guidelines is the surgical technique. Operational considerations to optimize a successful procedure should include checklists, preassembled kits, and robust quality improvement and insurance after a cricothyrotomy is performed.

Conclusions

By focusing on technical, educational, and operation considerations relating to prehospital cricothyrotomy, prehospital clinicians can optimize the chance for procedural success.
院前环甲环切开术:技术、教育和操作优化的叙述回顾。
背景:明确的气道管理是院前设置的一项必要技能,通常通过气管内插管或声门上气道完成。当临床医生遇到不能供氧和不能通气的情况时,仍然必须保护患者的气道。院前环甲环切开术是一种高灵敏度、低频率的手术,用于通过前颈部固定气道。需要环甲环切开术的患者通常有明显的合并症和死亡率,并且手术并发症的发生率很高。执行环甲环切开术的能力在许多院前临床医生的实践范围内,掌握该程序对患者的预后至关重要。尽管如此,关于手术的初步培训很少,护理人员报告说他们执行手术的能力不舒服。目的:回顾和总结有关环甲环切开术的最佳证据,并提出技术、教育和操作方面的考虑,以尽量减少并发症和优化院前环甲环切开术的成功率。讨论:院前行环甲环切开术时的技术考虑可用于减轻气道错位、主插管和出血。教育方面的考虑应该包括专注于一种单一的技术,使用既定的课程,通过模拟或心理练习进行间隔重复,以及专注于何时执行程序的意图训练。国家紧急医疗服务协会(EMS)医师指南的首选技术是手术技术。优化手术成功的操作考虑因素应包括检查清单,预组装的试剂盒,以及环甲环切开术后强有力的质量改进和保险。结论:院前临床医生通过关注院前环甲环切开术的技术、教育和操作方面的考虑,可以优化手术成功的机会。
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来源期刊
Journal of Emergency Medicine
Journal of Emergency Medicine 医学-急救医学
CiteScore
2.40
自引率
6.70%
发文量
339
审稿时长
2-4 weeks
期刊介绍: The Journal of Emergency Medicine is an international, peer-reviewed publication featuring original contributions of interest to both the academic and practicing emergency physician. JEM, published monthly, contains research papers and clinical studies as well as articles focusing on the training of emergency physicians and on the practice of emergency medicine. The Journal features the following sections: • Original Contributions • Clinical Communications: Pediatric, Adult, OB/GYN • Selected Topics: Toxicology, Prehospital Care, The Difficult Airway, Aeromedical Emergencies, Disaster Medicine, Cardiology Commentary, Emergency Radiology, Critical Care, Sports Medicine, Wound Care • Techniques and Procedures • Technical Tips • Clinical Laboratory in Emergency Medicine • Pharmacology in Emergency Medicine • Case Presentations of the Harvard Emergency Medicine Residency • Visual Diagnosis in Emergency Medicine • Medical Classics • Emergency Forum • Editorial(s) • Letters to the Editor • Education • Administration of Emergency Medicine • International Emergency Medicine • Computers in Emergency Medicine • Violence: Recognition, Management, and Prevention • Ethics • Humanities and Medicine • American Academy of Emergency Medicine • AAEM Medical Student Forum • Book and Other Media Reviews • Calendar of Events • Abstracts • Trauma Reports • Ultrasound in Emergency Medicine
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