Emergency percutaneous tracheotomy in failed intubation

ObjectiveCricothyrotomy is the emergency surgical means of gaining access to the airways. However it holds a lot of problems to the patient and is only a temporary measure until a definitive airway is reached. Griggs’ forceps technique for elective bedside percutaneous dilational tracheotomy (PDT) is safe, fast, and carries fewer complications in expert hands. This study aimed at comparing between emergency cricothyrotomy and emergency PDT in patients with failed intubation.DesignA comparative double blind study.SettingEmergency room of Alexandria main university hospitals.Patients169 failed to intubate, failed to ventilate patients.MethodsThey were serially randomized into group I (85 patients): percutaneous cricothyrotomy and group II (84 patients): PDT using Griggs’ forceps technique.ResultsSuccess rate was 95.3% in group I and 97.6% in group II. Procedure duration (in minutes) was 1.85 ± 0.36 in group I versus 1.46 ± 0.31 in group II. Lung atelectasis occurred to 8.2% of patients in group I only. Vocal cord injury occurred to 4.7% of patients in group I versus 1.2% in group II.ConclusionEmergency PDT is feasible and safe in expert hands.