Clinical Trials Logo

Clinical Trial Summary

Cricothyroid membrane (CTM) localization is a critical step prior to emergent surgical airway access. Ultrasound-guided localization of the CTM on the skin of the neck had been suggested prior to induction of general anesthesia so that a marked entry point can be used to quickly establish emergent front of neck access if required. In this prospective observational study, the investigators aim to determine the potential for migration of the CTM markings in the sagittal plane during neck repositioning.


Clinical Trial Description

As defined in recent difficult airway guidelines, successful and rapid cricothyroidotomy depends on identification of the cricothyroid membrane (CTM), coupled with skillful and efficient technique. Unfortunately, identification of the CTM is often inaccurate and complicated by patient factors such as female gender and obesity. Further studies go on to demonstrate the rates for correct identification of the CTM using palpation methods are low and range between 11% and 42%, with even lower success of identifying the midline of the CTM. This traditional palpation method was demonstrated to be fraught with error by different users including: 2 finger palpation, 4 finger palpation, and neck crease successfully identified the CTM 62%, 46%, and 50% of the time at time intervals between 11-14 seconds in non emergency settings.

As a result of previously mentioned patient factors and multiple technical factors, including poor landmarking, cricothyrotomy has a failure rate as high as 60%, exposing patients to high risks of mortality and morbidity. Therefore, more accurate methods of CTM identification are greatly needed at present.

Suggestions of implementing ultrasound in airway management have been brought forth, with applications such as predicting airway difficulty prior to instrumentation, confirming endotracheal tube position, or marking the CTM prior to induction of anesthesia. There have been multiple studies addressing questions such as mean time to identification of CTM in obese subjects using ultrasound and comparison of transverse versus longitudinal scanning technique. One group assessed translational movement of the CTM in neutral neck position versus extended in 23 healthy volunteers, and found a difference in transverse and longitudinal markings of 0.91mm and 1.04mm respectively, with CTM length ranging from 10.6mm to 17mm.

Of interest to the investigators is using ultrasound to predict CTM position accurately and ensuring ability to gain emergency airway access, as the accuracy of ultrasound identification of the CTM in different neck positions is unknown. What is specifically unknown is the translational movement of the cricoid between neck positions.

Therefore, the investigators propose an observational prospective trial looking at cricoid cartilage translation with three different neck positions: neck neutral, neck extension, and neck sniffing. The investigators will use GE Venue 50 (GE HealthcareTM) ultrasound machine, and a linear transducer probe with a frequency of 8-13MHz (GE LOGIQ 12L-SC) for measurements. The measurements will originate at the sternal notch to the superior border of the cricoid cartilage where the cricoid membrane inserts. These will also be referenced to exterior skin markings. The outcomes will address if the airway significantly moves during manipulation by the degree of cricoid cartilage translation between neutral, sniffing and extended neck positions. Secondarily, The investigators will also aim to address the directionality of a pre-marked neck and cricoid migration with neck manipulation. ;


Study Design


Related Conditions & MeSH terms


NCT number NCT04124770
Study type Observational
Source University of British Columbia
Contact
Status Completed
Phase
Start date November 9, 2018
Completion date October 9, 2019

See also
  Status Clinical Trial Phase
Completed NCT04546867 - Establishing a Sonographic Based Algorithm to Verify Pancreatic Stent Position Placed to Prevent Post-ERCP Pancreatitis Before Endoscopic Removal N/A
Not yet recruiting NCT06053892 - AR US Versus sUS or Fluoroscopic Injections for Shoulder Punction N/A
Completed NCT05013476 - Tele-Ultrasound: VIrtual Hands-on Education for Novice Users N/A
Completed NCT04554472 - Usefulness of Intraoperative Ultrasound in a Volar Plate Distal Radius Fixation
Not yet recruiting NCT06456957 - Fetal Abdominal Subcutaneous Tissue Thickness in Prediction of Fetal Weight in Term Pregnant Women
Not yet recruiting NCT04550793 - Using Shear Wave Ultrasound Elastography for Follow up After Anti-spastic Intervention Among Stroke Patients
Completed NCT03563196 - Diagnosis Of Pulmonary Complications After Cardiac Surgery In Children
Completed NCT01666626 - Ultrasound Stiffness Imaging in Crohn's Disease N/A
Active, not recruiting NCT04928560 - Diagnosis of Superficial Lymphadenopathy
Recruiting NCT05938790 - Point of Care Ultrasound in Obstetric Triage N/A
Completed NCT06098105 - Laparoscopic vs Ultrasound-Guided Transversus Abdominis Plane Block vs Laparoscopic Intraperitoneal Instillation of Local Anesthetic in Pediatrics N/A
Recruiting NCT02834585 - Magnetic Resonance Imaging or Ultrasound in Soft Tissue Tumors (MUSTT) N/A
Completed NCT02661607 - Point of Care Echocardiography Versus Chest Radiography for the Assessment of Central Venous Catheter Placement N/A
Completed NCT01519167 - Open-Label, Safety Study Evaluating the Use of Dexmedetomidine in Pediatric Subjects Undergoing Procedure-Type Sedation Phase 4
Completed NCT04612816 - Live Stream of Ultrasound in Prehospital Medical Care
Active, not recruiting NCT06195488 - Gastric Ultrasound in Diabetic Patients
Recruiting NCT06199856 - Assessment System for Sarcopenia Based on Ultrasonographic Data
Completed NCT04574258 - Prospective Multicenter Study on Clinical Application of Sonozoid in Thyroid Tumor
Not yet recruiting NCT04563897 - Prospective Multicenter Study on Clinical Application of Sonazoid in Liver Tumor
Completed NCT04229654 - Awareness, Expectations, and Perception of Anomaly Scan Among Mexican Pregnant Women