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Accuracy of ultrasound in measurement of the paediatric cricothyroid membrane

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Authors: Walsh B et a;

Paediatric Anaesthesia (May 2019)

BACKGROUND Emergency front of neck airway is a recommended airway rescue strategy in children over one 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 are 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 paediatric cricothyroid membrane may assist clinicians in determining the feasibility of emergency front of neck airway, optimum technique and equipment.

AIM To assess the accuracy of ultrasound assisted paediatric cricothyroid membrane localization and dimension measurement using magnetic resonance imaging as the reference standard.

METHODS After structured training two paediatric anaesthesiology trainees used ultrasound to identify and measure the dimensions of the cricothyroid membrane in paediatric patients undergoing elective magnetic resonance imaging of the head and neck under general anesthesia. A paediatric 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 paediatric patients. This approach could have clinical and research utility.

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