The effect of patient positioning on ultrasound landmarking for cricothyrotomy
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REPORTS OF ORIGINAL INVESTIGATIONS
The effect of patient positioning on ultrasound landmarking for cricothyrotomy Lauren Arthurs, MD . Shannon Erdelyi, MSc . Daniel J. Kim, MD Received: 20 January 2020 / Revised: 28 June 2020 / Accepted: 12 July 2020 Ó Canadian Anesthesiologists’ Society 2020
Abstract Purpose Our primary objective was to assess the difference in position of the ultrasound-guided landmark of the cricothyroid membrane (CTM) when performed with the supine patient positioned at different head of bed (HOB) elevations. Methods In this prospective observational study of patients presenting to the emergency department with non-life-threatening complaints, subjects underwent ultrasound-guided landmarking of the CTM with HOB elevation at 0°, 30°, and 90°. A linear mixed effects regression model was used to assess the change in the CTM landmark associated with head position. We used a second adjusted linear mixed effects model to assess possible confounding patient factors associated with these changes. Results One-hundred and ten patients were enrolled, with a median [interquartile range] age of 39 [29-59] yr and 51:49 female:male ratio. Head of bed elevation at 30° and 90° resulted in a cephalad change in the CTM landmark of 2.7 mm (99% confidence interval [CI], 1.7 to 3.8; P \ 0.001) and 4.2 mm (99% CI, 3.2 to 5.3; P \ 0.001) respectively compared with the landmark at 0°. Body mass index (BMI) was associated with a change of 4.6 mm (99% CI, 0.5 to 8.7; P = 0.004) for BMI C 30 compared with
Prior presentations: American Institute of Ultrasound in Medicine Annual Convention, New York, NY, 26 March 2018; Canadian Association of Emergency Physicians (CAEP) Annual Conference, Calgary, Alberta, 28 May 2018. L. Arthurs, MD S. Erdelyi, MSc Department of Emergency Medicine, University of British Columbia, 2775 Laurel St, Vancouver, BC V5Z 1M9, Canada D. J. Kim, MD (&) Department of Emergency Medicine, University of British Columbia, 2775 Laurel St, Vancouver, BC V5Z 1M9, Canada e-mail: [email protected] Department of Emergency Medicine, Vancouver General Hospital, Vancouver, BC, Canada
\ 18.5 kgm-2 The impact of patient age on distance depended on HOB elevation, where patients [ 70 yr had a change of 2.6 mm (99% CI, 0.01 to 5.1; P = 0.009) at 90° HOB elevation compared with 30°. Conclusion The location of the ultrasound-identified surface landmark of the CTM moves in a cephalad direction by changing the position of the HOB from supine 0° to elevation at 30° and 90°. This may be clinically important when attempting cricothyrotomy using a percutaneous (blind) technique, particularly when CTM identification and cricothyrotomy are performed at different head elevations. Re´sume´ Objectif Notre objectif principal e´tait d’e´valuer la diffe´rence de position de la membrane cricothyroı¨dienne en tant que repe`re e´choguide´ selon qu’elle est identifie´e a` diffe´rentes e´le´vations de la teˆte du lit avec le patient en de´cubitus dorsal. Me´thode Cette e´tude observationnelle prospective a inclus des patients se pr
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