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12/05/2017

Membrane Cricoïdienne: Histoire de hauteur

The height of the cricothyroid membrane on computed tomography scans in trauma patients

Nutbeam T. et Al. Anaesthesia. 2017 May 2. doi: 10.1111/anae.13905.

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Un travail très intéressant qui met en avant le fait que la hauteur de la membrane cricoïdienne est moindre que ce que l'on pensait, qu'elle est en fait peu dépendante des conditions d'extension du cou et qu'une canule de 6 mm n'est pas celle qui sera insérée le plus facilement. 

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Emergency cricothyrotomy is a common feature in all difficult airway algorithms. It is the final step following a ‘can’t intubate, can’t oxygenate’ scenario. It is rarely performed and has a significant failure rate. There is variation in the reported size of the cricothyroid membrane, especially across population groups. Procedural failure may result from attempting to pass a device with too large an external diameter through the cricothyroid membrane. We aimed to determine the maximum height of the cricothyroid membrane in a UK trauma population. Electronic callipers were used to measure the maximum height of the cricothyroid membrane on 482 reformatted trauma computed tomography scans, 377 (78.2%) of which were in male patients. The mean (SD) height of the cricothyroid membrane, as independently measured by two radiologists, was 7.89 (2.21) mm and 7.88 (2.22) mm in male patients, and 6.00 (1.76) mm and 5.92 (1.71) mm in female patients. The presence of concurrent tracheal intubation or cervical spine immobilisation was found not to have a significant effect on cricothyroid membrane height.

Device External diameter; mm Proportion of study population in whom the mean cricothyroid membrane height > external diameter of device
6.0 mm internal diameter tracheal tube 8.0 36.2%
5.0 mm internal diameter tracheal tube 6.7 60.5%
4.0 mm internal diameter tracheal tube 5.6 77.6%
3.0 mm internal diameter tracheal tube 4.2 93.2%
Shiley tracheostomy 7.5 mm internal diameter 10.8 7.7%
Melker cricothyrotomy set 8.2 34.6%
TracheoQuick cricothyrotomy set 5.0 86.5%

The cricothyroid membrane height in the study population was much smaller than that previously reported.Practitioners encountering patients who may require an emergency surgical airway should be aware of these data. Rescue airway equipment with variety of external diameters should be immediately available.

| Tags : airway

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