Comparisons of airway establishment among four surgical methods / 中华急诊医学杂志

ABSTRACT

Objective To compare efficacy, time consumed and complications among cricothyroid membrane puncture guided tracheostomy ( CMPGT ) , surgical tracheostomy ( ST ) , surgical cricothyroidotomy ( SC) , and percutaneous tracheostomy using Griggs'guide wire dilating forceps ( GWDF) for the establishment of airway in urgent need of medical attention.Methods Twenty miniature swine were randomly ( random number) divided into four groups.The procedures of CMPGT, ST, SC and GWDF were carried out when patients'SpO2 ( oxygen saturation of blood ) declined to 80% by suspension of oxygen supply after general anesthesia. Procedure performed time, ventilation resumed time, SpO2 and electrocardiograph ( ECG) and arterial blood gases ( ABG) analysis including SaO2 , PaO2 , PaCO2 , blood pH, and heart rate, blood pressure were recorded.Fiberoptic bronchoscope was used to assess any damage to the tracheal wall.Complications were noted and scored in a two-month follow-up period.Results Airways were successfully established in all swine.The times consumed for SC, GWDF, CMPGT, and ST were (86 ±12) s, (165 ±63) s, (174 ±34) s, and (519 ±128) s, respectively, however a shorter time for ventilation resumed was found in CMPGT procedure (23 ±4) s, P<0.01.ECG showed that SpO2 and T-wave decreased and Q-T shortened after oxygen suspension and recovered to normal level rapidly after ventilation.There were significant differences in ECG and ABG between pre-and post-operative periods ( P<0.05) in all groups.Minimal intra-operative bleeding was found in two swine of each group.In ST group, moderate intra-operative bleeding was encountered in three swine.Three pigs were suffered from hypotension owing to prolonged hypoxemia.There was minimal postoperative bleeding occurred in one swine, thus leading to stoma infection.In SC group, moderate intra-operative bleeding was noticed in one swine. One miniature swine had slight injury at laryngeal cartilage resulting in difficult decannulation happened in one swine.and moderate tracheal wall injury occurred in one swine of GWDF group.The complication scores of CMPGT, GWDF, SC and ST were 3, 5, 9, and 19, respectively.Conclusions A shorter time for ventilation resumed with fewer complications was found in the procedure of CMPGT than that in the other methods.This animal study suggested that CMPGT was a time-saving and secure technique for emergency surgical airway establishment which has been practiced in human being as well.Key words:Surgical airway establishment, Cricothyroidotomy, Tracheostomy, Percutaneous dilational tracheostomy.