Cricothyrotomy: possible first-choice emergency airway access for treatment of acute upper airway obstruction in dogs and cats
- 1Universitetshospitalet for familiedyr, Dyrlaegevej 16, Frederiksberg 1870, Denmark
- 2Universitetshospitalet for Familiedyr, Dyrlaegevej 16, Frederiksberg 1870, Denmark
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Cricothyrotomy (CTT) for emergency access to the upper airway is a life-saving procedure in acute upper airway obstructions, and has been used in human emergency medicine since the 1920s (Koopmann and others 1981, Patel 1999). CTT has gained little attention in veterinary medicine, and only few reports are available.
In veterinary emergency medicine, tracheotomy (TT) is the recommended procedure for emergency access to the upper airway in the ‘cannot intubate cannot ventilate’ situation (Drobatz and Costello 2007, Ford and Mazzaferro 2011). In human beings, CTT is most commonly recommended (Orebaugh and Bigeleisen 2007, Bangalore and Grier 2009).
Several conditions can lead to the ‘cannot intubate cannot ventilate event’ and life-threatening asphyxia. In dogs and cats, anatomical malformations seen in brachycephalic breeds, in particular, oropharyngeal or laryngeal pathology, such as neoplasia, laryngitis and laryngeal oedema, oral or laryngeal trauma, foreign bodies, trismus and surgery related bleeding, in general, may be, encountered in these situations (Boon and others 2004). Fast intervention in order to reverse hypoxia is essential. In human beings, asphyxia after upper airway obstruction may be fatal after only four to five minutes (Ganong 1993). For emergency upper airway access, CTT may be preferable to TT because the procedure is technically simple, easy to learn and safe to perform. The aim of this review is to describe the CTT procedure in dogs and cats, and to discuss potential advantages and disadvantages in comparison with emergency TT.
Canine and feline laryngeal anatomy
The laryngeal anatomy, illustrated in Fig 1 is similar in dogs and cats. The cricothyroid membrane is a dense fibroelastic membrane on the ventral aspect of the larynx, between the cricoid cartilage caudally and the thyroid cartilage cranially. Part of the cricothyroid membrane is laterally covered by the cricothyroid muscles. There are no major vessels and nerves in the area of …