From: Erik Schobitz
> Needle cric was performed with an 18 guage angiocath...briefly able to oxygenate, but lost the needle cric while trying to re-start her heart - she unfortunately died.
--> My personal experience on this issue...
Please forgive the style. I am autistic and write things a bit more "black & white" than perhaps you are used to...
Based upon work in a "Level 1 Trauma Centre" equivalent in the UK and experience since the late 80s, including various environments and pre-hospital work. Also teach on ATLS, etc and thus try to keep up to date...
- Needle cric has NO advantages over "proper" cric
- As you have already experienced, it does have a number of disadvantages...
- Main causes for failure with needles:
- It often produces a "core biopsy" of skin & tissue, which blocks the needle and thus fails. This may be overcome by having 0.5ml of saline in a syringe to flush it
- It often blocks LATER by blood or secretions
- Over-needle caths are flimsy and WILL kink
- ALL THESE BLOCKAGES, at any stage, are OFTEN missed and go unnoticed!!!
- Many needles, designed to CUT through skin, have a long, sharp bevel, dangerous for the posterior internal aspects of the younger smaller tracheas...
- It only provides oxygenation, not allowing CO2 to be removed
- High pressure required to oxygenate - with its dangers
- Tough to monitor: usually no chest rise and no CO2 monitoring...
- Difficult to secure (especially without kinking)... As in the case mentioned...
- I will not bore you with how a needle has no cuff, like the proper cric kits do...
- There are a number of suitable task-specific cric kits, rather than "adapting" a needle or angiocath for a task they are not designed for - this temporising measure was invented over 25 years ago, BEFORE all the modern kits and training became available. We should no longer be using 2nd best
- ATLS still teaches both methods. The needle version being supposed to "buy time". There is the understandable (but mistaken) assumption, because we are still teaching it, that there must be some use for it. YES - if you do not possess the proper equipment (e.g. you work in some poor 3rd world environment), then you can think needle cric
- Hope you're sitting down, but a lot of military and other pre-hospital teaching is that definitive cric is even the choice BEFORE oral intubation, ESPCIALLY for non-experts in intubation. Think about it - intubation is a skill so much time is spent learning and practising and worrying about the difficulties and failures of. But finding the cric membrance and getting something through it is not as tough as finding the cords! There is no frequent problem with "visualisation" or secretions or bleeding in the way... No problem with positioning in trauma patients. MUCH MUCH MUCH easier to teach new paramedics to do well than is intubation!
> Ugly situation all the way around but if you get to that point I belive your likelihood of survival is pretty low no matter what you do.
--> "Likelihood of survival"?
That's epidemiology! NOT emergency medicine...
You have a patient. You do your best. The statistics will take care of themselves.
Which means that, if you THINK you need a DEFINITIVE AIRWAY, you might as well put one in. Then, at least, even in your case, if the patient does unfortunately die, it's DEFINITELY NOT because some second-best device (needle cric) has failed.
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