Rapid percutaneous tracheal catheterization using electrical guidance

摘要

Percutaneous needle tracheostomy or cricothyroidotomy establishes emergent airway access in situations of "cannot ventilate, cannot intubate. Currently, most clinicians and paramedics rely on palpation of anatomical landmarks and aspiration of air to guide needle puncture and confirm needle placement into the trachea. However, landmarking through palpation can be unreliable due to variability in patient sex, size, and body composition, and true aspiration of air from the trachea is hard to interpret in many cases. Moreover, difficulties can arise during needle insertion, including inability to cannulate the airway and perforation of the posterior or lateral aspects of the tracheal wall. Multiple attempts at needle insertion may be required, heightening these risks. Consequently, the complication rate of needle tracheostomy or cricothyroidotomy in emergency situations can be as high as 40%. Given this high complication rate and the critical and time-sensitive nature of the procedure, most physicians and paramedics would benefit from a reliable, objective, and unsophisticated method to increase its speed and accuracy.