Letters To The Editor: Letters & Announcements
To the Editor:
For years, emergency airway management has included needle cricothyrotomy as one of the invasive options after unsuccessful laryngoscopy (1). An angiocatheter is inserted through the cricothyroid membrane and air is aspirated after the needle enters the airway, followed by advancement of the catheter and connection to an appropriate jet ventilation device (2,3).
During a recent difficult airway management workshop, when gathering supplies from the operating suite, we were unable to locate any angiocatheters other than “protected” BD InSyte™ Autogard™ catheters (BD, Franklin Lakes, NJ). Because of the unique features of the catheter, it is not possible to connect a syringe for the purpose of aspiration, making it impossible to perform this life-saving procedure with this device (Fig. 1).
As a component of the needleless system, protected catheters provide a measure of safety from inadvertent needle sticks, but unfortunately do not permit other applications for them. Although catheter systems are marketed specifically for cricothyrotomy, we suggest the advisability of having simple “unprotected” angiocatheters available in every anesthesia cart as an added measure of airway safety.
Roy Soto, MD
Alonso Mesa, MD
1. ASA Task Force on Management of the Difficult Airway. Practice guidelines for management of the difficult airway. Anesthesiology 1993; 78: 597–602.
2. Patel RG. Percutaneous transtracheal jet ventilation: a safe, quick, and temporary way to provide oxygenation and ventilation when conventional methods are unsuccessful. Chest 1999; 116: 1689–94.
3. Peak DA, Roy S. Needle cricothyroidotomy revisited. Pediatr Emerg Care 1999; 5: 224–6.