scholarly journals Accuracy of digital palpation and laryngeal handshake in identification of cricothyroid membrane: An observational study

2020 ◽  
Vol 24 (2) ◽  
pp. 168-174
Author(s):  
Khor Whuan Wyeen ◽  
Syarifah Noor Nazihah Sayed Masri ◽  
Aliza Mohammad Yusof ◽  
Azarinah Izaham ◽  
Siti Nidzwani Mohammad Mahdi ◽  
...  
Keyword(s):  
Observational Study ◽  
Cricothyroid Membrane ◽  
Anterior Neck ◽  
Digital Palpation ◽  
Neck Anatomy ◽  
Surgical Airway

Background: Evaluation of the anterior neck anatomy is essential to identify the cricothyroid membrane (CTM) before invasive surgical airway. This study aimed to compare the accuracy of cricothyroid membrane identification done by digital palpation (DP) method and laryngeal handshake palpation (LHP). 

Ultrasound Improves Cricothyrotomy Success in Cadavers with Poorly Defined Neck Anatomy

2015 ◽  
Vol 123 (5) ◽  
pp. 1033-1041 ◽  
Author(s):  
Naveed Siddiqui ◽  
Cristian Arzola ◽  
Zeev Friedman ◽  
Laarni Guerina ◽  
Kong Eric You-Ten
Keyword(s):  
Ultrasound Guidance ◽  
Airway Device ◽  
Insertion Time ◽  
Anatomical Landmarks ◽  
Cricothyroid Membrane ◽  
Digital Palpation ◽  
Device Placement ◽  
Human Cadavers ◽  
Neck Anatomy ◽  
The Mean

Abstract Background Misidentification of the cricothyroid membrane in a “cannot intubate-cannot oxygenate” situation can lead to failures and serious complications. The authors hypothesized that preprocedure ultrasound-guided identification of the cricothyroid membrane would reduce complications associated with cricothyrotomy. Methods A group of 47 trainees were randomized to digital palpation (n = 23) and ultrasound (n = 24) groups. Cricothyrotomy was performed on human cadavers by using the Portex® device (Smiths Medical, USA). Anatomical landmarks of cadavers were graded as follows: grade 1—easy = visual landmarks; 2—moderate = requires light palpation of landmarks; 3—difficult = requires deep palpation of landmarks; and 4—impossible = landmarks not palpable. Primary outcome was the complication rate as measured by the severity of injuries. Secondary outcomes were correct device placement, failure to cannulate, and insertion time. Results Ultrasound guidance significantly decreased the incidence of injuries to the larynx and trachea (digital palpation: 17 of 23 = 74% vs. ultrasound: 6 of 24 = 25%; relative risk, 2.88; 95% CI, 1.39 to 5.94; P = 0.001) and increased the probability of correct insertion by 5.6 times (P = 0.043) in cadavers with difficult and impossible landmark palpation (digital palpation 8.3% vs. ultrasound 46.7%). Injuries were found in 100% of the grades 3 to 4 (difficult–impossible landmark palpation) cadavers by digital palpation compared with only 33% by ultrasound (P < 0.001). The mean (SD) insertion time was significantly longer with ultrasound than with digital palpation (196.1 s [60.6 s] vs. 110.5 s [46.9 s]; P < 0.001). Conclusion Preprocedure ultrasound guidance in cadavers with poorly defined neck anatomy significantly reduces complications and improves correct insertion of the airway device in the cricothyroid membrane.

Accuracy of conventional digital palpation and ultrasound of the cricothyroid membrane in obese women in labour

Anaesthesia ◽  
2015 ◽  
pp. n/a-n/a ◽  
Author(s):  
K. E. You-Ten ◽  
D. Desai ◽  
T. Postonogova ◽  
N. Siddiqui
Keyword(s):  
Cricothyroid Membrane ◽  
Obese Women ◽  
Digital Palpation

Autonomous Cricothyroid Membrane Detection Using Neural Networks for First-Aid Surgical Airway Management

2020 ◽  
Author(s):  
Xiaoxue Han ◽  
Hailin Ren ◽  
Pinhas Ben-Tzvi
Keyword(s):  
Airway Management ◽  
Spatial Information ◽  
Region Of Interest ◽  
First Aid ◽  
Cricothyroid Membrane ◽  
Global Features ◽  
Severe Injuries ◽  
Anatomy And Physiology ◽  
Surgical Airway ◽  
Improved Performance

Abstract Airway management is one of the most important priorities when dealing with patients with severe injuries, but knowledge of the important anatomy and physiology is needed for providers to perform a successful surgery. This paper provides a solution for the precise cricothyroid membrane detection problem for real-time surgical airway management applications. With a commercial compact and portable cricothyrotomy kit, the proposed method will enable providers with general knowledge to perform successful first-aid airway management. In this paper, we propose a Hybrid Neural Network (HNNet), consisting of two parallel computing ensembles. The first ensemble takes as an input a low-resolution global image and outputs the Region-of-Interest (ROI) from the predefined grids. The high-resolution image is then cropped according to the ROI, and fed into the second ensemble to achieve precise keypoint detection. Global features and their spatial information from the first ensemble are also fed into the second ensemble to improve the precision. A dataset that consists of over 16,000 images from 13 subjects is built, and the location of the cricothyroid membrane in each image is precisely labeled by medical experts. The training results are presented to show both the efficiency and improved performance of our proposed method compared to existing ones.

Ultrasound Is Superior to Palpation in Identifying the Cricothyroid Membrane in Subjects with Poorly Defined Neck Landmarks

2018 ◽  
Vol 129 (6) ◽  
pp. 1132-1139 ◽  
Author(s):  
Naveed Siddiqui ◽  
Eugene Yu ◽  
Sherif Boulis ◽  
Kong Eric You-Ten
Keyword(s):  
Computed Tomography ◽  
Adverse Events ◽  
Primary Outcome ◽  
Cricothyroid Membrane ◽  
Computed Tomography Scan ◽  
Accurate Identification ◽  
Neck Anatomy ◽  
The Mean ◽  
Tomography Scan ◽  
Group Allocation

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Success of a cricothyrotomy is dependent on accurate identification of the cricothyroid membrane. The objective of this study was to compare the accuracy of ultrasonography versus external palpation in localizing the cricothyroid membrane. Methods In total, 223 subjects with abnormal neck anatomy who were scheduled for neck computed-tomography scan at University Health Network hospitals in Toronto, Canada, were randomized into two groups: external palpation and ultrasound. The localization points of the cricothyroid membrane determined by ultrasonography or external palpation were compared to the reference midpoint (computed-tomography point) of the cricothyroid membrane by a radiologist who was blinded to group allocation. Primary outcome was the accuracy in identification of the cricothyroid membrane, which was measured by digital ruler in millimeters from the computed-tomography point to the ultrasound point or external-palpation point. Success was defined as the proportion of accurate attempts within a 5-mm distance from the computed-tomography point to the ultrasound point or external-palpation point. Results The percentage of accurate attempts was 10-fold greater in the ultrasound than external-palpation group (81% vs. 8%; 95% CI, 63.6 to 81.3%; P < 0.0001). The mean (SD) distance measured from the external-palpation to computed-tomography point was five-fold greater than the ultrasound to the computed-tomography point (16.6 ± 7.5 vs. 3.4 ± 3.3 mm; 95% CI, 11.67 to 14.70; P < 0.0001). Analysis demonstrated that the risk ratio of inaccurate localization of the cricothyroid membrane was 9.14-fold greater with the external palpation than with the ultrasound (P < 0.0001). There were no adverse events observed. Conclusions In subjects with poorly defined neck landmarks, ultrasonography is more accurate than external palpation in localizing the cricothyroid membrane.

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