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Accuracy of ultrasound in measurement of the pediatric cricothyroid membrane.
Paediatr Anaesth. 2019 07; 29(7):744-752.PA

Abstract

BACKGROUND

Emergency front of neck airway is a recommended airway rescue strategy in children over 1 year old. Surgical tracheostomy is advocated as the first-line technique, but in the absence of an ear, nose and throat surgeon cricothyroidotomy or tracheostomy is proposed. Recent research shows that clinical identification of the cricothyroid membrane is frequently inaccurate in older children and adults and has prompted investigation of ultrasound as a potential clinical tool for emergency front of neck airway. Advance knowledge of the dimensions of the pediatric cricothyroid membrane may assist clinicians in determining the feasibility of emergency front of neck airway, optimum technique, and equipment.

AIMS

The aim of this study was to assess the accuracy of ultrasound-assisted pediatric cricothyroid membrane localization and dimension measurement using magnetic resonance imaging as the reference standard.

METHODS

After structured training, two pediatric anesthesiology trainees used ultrasound to identify and measure the dimensions of the cricothyroid membrane in pediatric patients undergoing elective magnetic resonance imaging of the head and neck under general anesthesia. A pediatric radiologist reviewed the corresponding magnetic resonance imaging scans and measured the height of the cricothyroid membrane. The accuracy of the cricothyroid membrane height as measured by ultrasound was compared to that measured by magnetic resonance imaging.

RESULTS

Twenty-two patients were included in the study. The cricothyroid membrane was accurately identified by ultrasound in all cases. The correlation coefficient for cricothyroid membrane height measured by ultrasound and that measured by magnetic resonance imaging was 0.98 (95% C.I 0.95-0.99, P < 0.0001). The bias was -0.16 mm and the precision was 0.19 mm. All differences were within the a priori limits of agreement. The 95% limits of agreement were -0.54 to 0.22 mm.

CONCLUSION

Ultrasound can be used to accurately identify and measure cricothyroid membrane height in pediatric patients. This approach could have clinical and research utility.

Authors+Show Affiliations

Department of Anaesthesia and Critical Care Medicine, Our Lady's Children's Hospital Crumlin, Dublin, Ireland.Department of Anaesthesia and Critical Care Medicine, Our Lady's Children's Hospital Crumlin, Dublin, Ireland.Department of Anaesthesia, The Rotunda Hospital, Dublin, Ireland.Department of Radiology, Our Lady's Children's Hospital Crumlin, Dublin, Ireland.Department of Anaesthesia and Critical Care Medicine, Our Lady's Children's Hospital Crumlin, Dublin, Ireland.Department of Anaesthesia, The Rotunda Hospital, Dublin, Ireland.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31063634

Citation

Walsh, Bill, et al. "Accuracy of Ultrasound in Measurement of the Pediatric Cricothyroid Membrane." Paediatric Anaesthesia, vol. 29, no. 7, 2019, pp. 744-752.
Walsh B, Fennessy P, Ni Mhuircheartaigh R, et al. Accuracy of ultrasound in measurement of the pediatric cricothyroid membrane. Paediatr Anaesth. 2019;29(7):744-752.
Walsh, B., Fennessy, P., Ni Mhuircheartaigh, R., Snow, A., McCarthy, K. F., & McCaul, C. L. (2019). Accuracy of ultrasound in measurement of the pediatric cricothyroid membrane. Paediatric Anaesthesia, 29(7), 744-752. https://doi.org/10.1111/pan.13658
Walsh B, et al. Accuracy of Ultrasound in Measurement of the Pediatric Cricothyroid Membrane. Paediatr Anaesth. 2019;29(7):744-752. PubMed PMID: 31063634.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Accuracy of ultrasound in measurement of the pediatric cricothyroid membrane. AU - Walsh,Bill, AU - Fennessy,Paul, AU - Ni Mhuircheartaigh,Roisin, AU - Snow,Aisling, AU - McCarthy,Kevin F, AU - McCaul,Conan L, Y1 - 2019/05/27/ PY - 2019/02/17/received PY - 2019/04/09/revised PY - 2019/04/25/accepted PY - 2019/5/8/pubmed PY - 2020/6/12/medline PY - 2019/5/8/entrez KW - airway management KW - airway obstruction KW - larynx KW - pediatric emergency medicine KW - tracheostomy KW - ultrasonic surgical procedures SP - 744 EP - 752 JF - Paediatric anaesthesia JO - Paediatr Anaesth VL - 29 IS - 7 N2 - BACKGROUND: Emergency front of neck airway is a recommended airway rescue strategy in children over 1 year old. Surgical tracheostomy is advocated as the first-line technique, but in the absence of an ear, nose and throat surgeon cricothyroidotomy or tracheostomy is proposed. Recent research shows that clinical identification of the cricothyroid membrane is frequently inaccurate in older children and adults and has prompted investigation of ultrasound as a potential clinical tool for emergency front of neck airway. Advance knowledge of the dimensions of the pediatric cricothyroid membrane may assist clinicians in determining the feasibility of emergency front of neck airway, optimum technique, and equipment. AIMS: The aim of this study was to assess the accuracy of ultrasound-assisted pediatric cricothyroid membrane localization and dimension measurement using magnetic resonance imaging as the reference standard. METHODS: After structured training, two pediatric anesthesiology trainees used ultrasound to identify and measure the dimensions of the cricothyroid membrane in pediatric patients undergoing elective magnetic resonance imaging of the head and neck under general anesthesia. A pediatric radiologist reviewed the corresponding magnetic resonance imaging scans and measured the height of the cricothyroid membrane. The accuracy of the cricothyroid membrane height as measured by ultrasound was compared to that measured by magnetic resonance imaging. RESULTS: Twenty-two patients were included in the study. The cricothyroid membrane was accurately identified by ultrasound in all cases. The correlation coefficient for cricothyroid membrane height measured by ultrasound and that measured by magnetic resonance imaging was 0.98 (95% C.I 0.95-0.99, P < 0.0001). The bias was -0.16 mm and the precision was 0.19 mm. All differences were within the a priori limits of agreement. The 95% limits of agreement were -0.54 to 0.22 mm. CONCLUSION: Ultrasound can be used to accurately identify and measure cricothyroid membrane height in pediatric patients. This approach could have clinical and research utility. SN - 1460-9592 UR - https://www.unboundmedicine.com/medline/citation/31063634/Accuracy_of_ultrasound_in_measurement_of_the_pediatric_cricothyroid_membrane_ L2 - https://doi.org/10.1111/pan.13658 DB - PRIME DP - Unbound Medicine ER -