None listed
Conditions
Brief summary
A small number of patients who are brought to the emergency department need a general anaesthetic. This lets us help them by keeping their airway open and breathing for them, and allows us to perform tests and provide further treatment. In very rare cases, the breathing tube cannot be passed through the mouth. This is a life threatening emergency, and an emergency procedure called a cricothyroidotomy then has to be performed. This involves making a cut in the front of the neck, directly into the windpipe, so that the breathing tube can be put directly into the airway. This is similar to a tracheostomy. The area of the neck where the cut is made is called the cricothyroid membrane, and it is usually identified by feeling the front of the neck with a finger. Recently, it has become clear that ultrasound scans can be used to locate the membrane, but it is not clear if this is more or less accurate than locating it by feel, and whether using an ultrasound takes more or less time. The study aims to compare two groups of patients. One group will have their cricothyroid membrane identified by touch, and the other group will have it identified by ultrasound. The participants in the study, will be randomly assigned (like tossing a coin) into one of these two groups. Immediately before having a CT scan, a doctor will try and locate the patients’ cricothyroid membrane using either touch or ultrasound (depending on the group they are randomised to), and then place a marker (a small metal cross) on the neck, which will be held in place with adhesive tape. After the CT scan, an x-ray specialist will then be able to see whether or not the marker has been placed accurately. We will then compare whether one method is more accurate than the other, as well as how long it took to place the marker. With the exception of (1) the attempt of cricothyroid membrane localisation, via ultrasound or landmark palpation and (2) placing a marker on their neck, the rest of the participants’ care will be carried out as normal.
Interventions
This study aims to compare the speed and accuracy of ultrasound versus landmark technique of identifying the cricothyroid membrane (CTM) and to secondarily assess the confidence of providers in the method that they have undertaken.
Patients will have their CTM identified via use of ultrasound immediately prior to undergoing routine CT imaging of the cervical spine. This will be performed by study staff (consultant emergency physicians or advanced trainees in emergency medicine, who have complet
This study aims to compare the speed and accuracy of ultrasound versus landmark technique of identifying the cricothyroid membrane (CTM) and to secondarily assess the confidence of providers in the method that they have undertaken. Patients will have their CTM identified via use of ultrasound immediately prior to undergoing routine CT imaging of the cervical spine. This will be performed by study staff (consultant emergency physicians or advanced trainees in emergency medicine, who have completed the training protocol and basic credentialing in emergency ultrasound, with at least eFAST and AAA competency). The CTM will marked by placement of a radiopaque marker and held in place using micropore tape. This will be removed at completion of the CT scan.
Sponsors
Dr Christopher Partyka
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Diagnosis
Masking
Blinded (masking used) (Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Emergency department patients aged greater than or equal to 18 years, requiring computed tomography of the cervical spine for any indication.
Exclusion criteria
GCS <15, inability to provide informed consent, haemodynamic instability, anterior neck wound or cellulitis, Cervical spine injury excluded by use of clinical decision rule (ie. NEXUS or Canadian C- spine Rule).
Outcome results
None listed