Emergent surgical airway for patients with head and neck conditions: a systematic review and meta-analysis

Acute airway obstruction in patients with head and neck conditions often results in a 'can't intubate, can't oxygenate' (CICO) situation, which requires a different management approach than the airway emergency guidelines in the context of anaesthesiology. This systematic review and meta-analysis synthesized and analysed the patient demographics, causes, presentations, complications, operators, and outcomes of emergent surgical airways performed in patients with head and neck conditions, and proposed a targeted management pathway. A total of 1011 emergent surgical airways reported in 14 studies were identified, including 961 tracheostomies and 50 cricothyrotomies. The analysis of patient demographics showed that 79% of the patients were male (95% confidence interval (CI) 73.3-84.1%), and mean age was 56.0 years (95% CI 51.5-60.5 years). The most common underlying cause was neoplasm (56.0%, 95% CI 37.4-73.7%). The most common preceding symptom was dyspnoea (66.6%, 95% CI 44.3-85.7%). The pooled mean complication rate was 16.8% (95% CI 8.8-26.6%). The airway-related mortality rate was 0.2% (95% CI 0.0-0.8%). The odds of successful decannulation were significantly increased in non-malignant tumour cases compared to malignant cases. The odds of complications were significantly increased for emergent surgical airways performed in locations other than the operating room.