Percutaneous tracheostomy: a new approach to the emergency airway

Endotracheal intubation is the preferred method of airway control. Current surgical standard of care for the emergent airway when endotracheal intubation cannot be performed is cricothyroidotomy. Percutaneous tracheostomy (PT) is a widely accepted technique for elective long-term airway management in the critical care setting. We describe our experience with successful placement of PT for emergency airway control.

After institutional review board approval was obtained, patients were identified retrospectively from January 2003 to present that had emergency PT performed as identified by the DRG International Classification of Diseases--9th Rev. procedure code (31.1). Data included demographics, body mass index, admitting service, size of tracheostomy tube, reason for urgent airway access, duration PT was required, unit, time and hospital day performed, and complications.

Eighteen patients underwent emergency PT; 61% were male, and age range was 21 years to 86 years. Indications for PT included respiratory failure associated with anaphylaxis, supraglottic edema, cardiac arrest, and blood or edema blocking the airway preventing intubation. PT was performed in various departments throughout the hospital. Admitting services included critical care intensivist (44.4%), trauma surgery (27.7%), cardiology (11.1%), medicine (11.1%), and neurology (5.5%). Most of the tracheostomy tube sizes were no. 8 (61.1%), followed by no. 7 (22.2%), no. 6 (5.5%), and no. 9 (5.5%). All PTs were successfully placed, and there were no complications. Ten of our patients had no airway in place at the time of procedure. Six patients had emergency esophageal-tracheal airways in place. Two patients had a cricothyroidotomy that was not functioning adequately. Nine patients had body mass indexes ranging from 30 kg/m² to 112 kg/m².

PT provided a safe, effective emergency airway in adult patients who presented with a variety of indications, in varying locations throughout the hospital. PT performed by appropriately trained personnel may be a potential adjunct for emergent airway control in diverse settings.