Andrew and Bruce are back, taking a deep-dive into the neck to discuss a procedure that can strike fear into even the most experienced trauma practitioner and one which has created much debate regarding the “best” method (i.e. needle vs knife). (Go to audio)
Bruce is the co-author of a seminal paper on this topic:
Emergency surgical cricothyroidotomy: 24 successful cases leading to a simple ‘scalpel-finger-tube’ method. Paix BR, Griggs WM Emerg Med Australas. 2012 Feb;24(1):23-30 (Full text available here – thanks EMCrit)
To date, between them, Bruce and Bill have performed 26 surgical airways. In this episode you will hear Bruce describe in detail his first-hand, real-world, extensive experience with this procedure and his rationale for supporting the simple “scalpel-finger-tube” technique over the many other methods that have been described. Andrew was also recently indoctrinated into the “cric-club” and provides some immensely valuable insights for those of us who are yet to do this procedure “in anger”.
This is a timely episode, with the Royal College of Anaesthetists (ROCA) UK only days ago publishing the findings of a working group of anaesthetists and ear, nose and throat surgeons that recommend the scalpel-bougie-tube technique as the preferred technique for front of neck access (FONA) in a can’t intubate, can’t oxygenate (CICO) situation. (Bruce discusses the pros and cons of using a bougie in the podcast!)
A description of the rationale for this paper from ROCA can be read here: