Incision depth in surgical airway management using computed tomography of the neck to minimize complications

Background

Swift and accurate airway management is crucial in the emergency department. Failure to secure the airway in hypoxic individuals can lead to severe outcomes, including brain damage or death. When a difficult airway is anticipated or intubation fails, alternatives such as cricothyroidotomy or tracheostomy must be considered, taking into account patient characteristics.

Aim

Analysis of the relationship between patient's characteristics and the depth of the cricothyroid membrane (CTM) and tracheostomy sites (TSs).

Methods

We conducted a retrospective cross-sectional study of patients who underwent neck CT scans in the emergency department and 475 patients were included. The shortest distance from the skin to the innermost surface of the CTM (CTM depth) was measured in the sagittal view of the CT. For tracheostomy, depths were measured from the skin at the cricoid cartilage (1–2 cm below) to the membranes between the second and third tracheal rings (TS1) and between the third and fourth rings (TS2). Patient characteristics, including age, sex, height, and weight, were recorded to assess correlations with depth through multiple linear regression analysis.

Results

The average CTM depth was 10.87 ± 3.93 mm, while the depths at TS1 and TS2 were 12.38 ± 4.72 mm and 14.75 ± 6.30 mm, respectively. Significant correlations were found between patient age, body mass index, sex, and the depths of the CTM and TSs 1 and 2. Older age and increased obesity were associated with greater depths, particularly at TS2. Notably, females exhibited greater depths at CTM and TS1 than males, with no significant differences at TS2.

Conclusions

These findings offer valuable insights for anticipating incision depth during urgent surgical airway procedures, potentially minimizing complications and improving treatment outcomes.