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February 04, 2016

How Fast Should an Emergency Tracheostomy Take?

Image courtesy of digitalart at FreeDigitalPhotos.net
When faced with an emergency airway situation, a surgical airway may be required in order to save a person's life. Such surgical airways include emergency tracheostomy or cricothyroidotomy.

The main question here is how quickly should such a procedure take in order for it to be considered a success? Clearly, it should take less than 4 minutes given that is how long a brain can survive without oxygen before permanent damage sets in.

According to the literature, the range of what is considered "acceptable" duration of time to perform an emergency surgical airway ranges from 40 to 180 seconds. Most consider shooting for a goal of 90 seconds to be a reasonable compromise of how long an emergency surgical airway should take to perform.

Of course, success is defined not only on how quickly it can be performed, but also performed without complications which principally includes inserting the breathing tube somewhere other than the windpipe. Other complications include cutting into the esophagus or perforating the carotid artery.


Reference:
Emergency cricothyroidotomy: a randomized crossover trial comparing the wire-guided and catheter-over-needle techniques. Anaesthesia. 2004 Oct;59(10):1008-11.

A comparison of four techniques of emergency transcricoid oxygenation in a manikin. Anesth Analg. 2010 Apr 1;110(4):1083-5

Emergency cricothyroidotomy: A randomized crossover trial comparing percutaneous techniques: Classic Needle First versus Incision First. Acad Emerg Med. 2012 Sep;19(9):E1061-7.

Emergency cricothyroidotomy - a systematic review. Scand J Trauma Resusc Emerg Med. 2013 May 31;21:43.




Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids. Google+ Christopher Chang, MD Bio

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