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The introduction of emergency cricothyroidotomy simulation training in Zimbabwe contributed to the saving of two lives

Published online by Cambridge University Press:  09 September 2016

M B Avnstorp ,
P V F Jensen ,
T Dzongodza ,
N Matinhira ,
C Chidziva ,
J Melchiors  and
C Von Buchwald
M B Avnstorp*
Affiliation:
Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
P V F Jensen
Affiliation:
Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
T Dzongodza
Affiliation:
Department of Otorhinolaryngology, Parirenyatwa Hospital, Harare, Zimbabwe
N Matinhira
Affiliation:
Department of Otorhinolaryngology, Parirenyatwa Hospital, Harare, Zimbabwe
C Chidziva
Affiliation:
Department of Otorhinolaryngology, Parirenyatwa Hospital, Harare, Zimbabwe
J Melchiors
Affiliation:
Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark Copenhagen Academy of Medical Simulation and Education, Rigshospitalet, Denmark
C Von Buchwald
Affiliation:
Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
*
Address for correspondence: Dr Magnus Balslev Avnstorp, Dept of Otorhinolaryngology, Head and Neck Surgery and Audiology, F2071, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark. E-mail: [email protected]
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Abstract

Background:

In developing countries with limited access to ENT services, performing emergency cricothyroidotomy in patients with upper airway obstruction may be a life-saving last resort. An established Danish–Zimbabwean collaboration of otorhinolaryngologists enrolled Zimbabwean doctors into a video-guided simulation training programme on emergency cricothyroidotomy. This paper presents the positive effect of this training, illustrated by two case reports.

Case reports:

A 56-year-old female presented with upper airway obstruction due to a rapidly progressing infectious swelling of the head and neck progressing to cardiac arrest. Cardiopulmonary resuscitation was initiated and a secure surgical airway was established via an emergency cricothyroidotomy, saving the patient. A 70-year-old male presented with upper airway obstruction secondary to intubation for an elective procedure. When extubated, the patient exhibited severe stridor followed by respiratory arrest. Re-intubation attempts were unsuccessful and emergency cricothyroidotomy was performed to secure the airway, preserving the life of the patient.

Conclusion:

Emergency cricothyroidotomy training should be considered for all surgeons, anaesthetists and, eventually, emergency and recovery room personnel in developing countries. A video-guided simulation training programme on emergency cricothyroidotomy in Zimbabwe proved its value in this regard.

Keywords

Airway ObstructionDeveloping CountriesOtorhinolaryngologic Surgical ProceduresEmergency CricothyroidotomyTracheostomySimulation Training
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 130 , Issue 10 , October 2016 , pp. 923 - 927
Copyright
Copyright © JLO (1984) Limited 2016 

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References

1 Zimbabwe National Statistics Agency. Zimbabwe Demographic and Health Survey 2010–11. In: https://dhsprogram.com/pubs/pdf/FR254/FR254.pdf [21 July 2016]Google Scholar
2 Fagan, JJ, Jacobs, M. Survey of ENT services in Africa: need for a comprehensive intervention. Glob Health Action 2009;2 Google Scholar
3 Cook, TM, Woodall, N, Harper, J, Benger, J. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 2: intensive care and emergency departments. Br J Anaesth 2011;106:632–42Google Scholar
4 Mock, CN, Donkor, P, Gawande, A, Jamison, DT, Kruk, ME, Debas, HT. Essential surgery: key messages from Disease Control Priorities, 3rd edition. Lancet 2015;385:2209–19CrossRefGoogle ScholarPubMed
5 Melchiors, J, Todsen, T, Konge, L, Charabi, B, von Buchwald, C. Cricothyroidotomy – the emergency surgical airway. Head Neck 2016;38:1129–31Google Scholar
6 Melchiors, J, Todsen, T, Nilsson, P, Wennervaldt, K, Charabi, B, Bottger, M et al. Preparing for emergency: a valid, reliable assessment tool for emergency cricothyroidotomy skills. Otolaryngol Head Neck Surg 2015;152:260–5CrossRefGoogle ScholarPubMed
7 Konge, L, Ringsted, C, Bjerrum, F, Tolsgaard, MG, Bitsch, M, Sorensen, JL et al. The Simulation Centre at Rigshospitalet, Copenhagen, Denmark. J Surg Educ 2015;72:362–5Google Scholar
8 Long, KL, Spears, C, Kenady, DE, Roth, JS. Implementation of a low-cost laparoscopic skills curriculum in a third-world setting. J Surg Educ 2014;71:860–4Google Scholar
9 Murphy, SC. The person behind the eponym: Wilhelm Frederick von Ludwig (1790–1865). J Oral Pathol Med 1996;25:513–15Google Scholar
10 Submandibular space infections (Ludwig's angina). In: http://www.uptodate.com/contents/submandibular-space-infections-ludwigs-angina [5 June 2015]Google Scholar
11 Bakir, S, Tanriverdi, MH, Gün, R, Yorgancilar, AE, Yildirim, M, Tekbaş, G et al. Deep neck space infections: a retrospective review of 173 cases. Am J Otolaryngol 2012;33:56–63 Google Scholar
12 Random House Kernerman Webster's College Dictionary. In: http://www.kdictionaries-online.com/DictionaryPage.aspx?ApplicationCode=18&SearchMode=Entry&DictionaryEntry=document [21 July 2016]Google Scholar
13 Mandal, A, Kabra, SK, Lodha, R. Upper airway obstruction in children. Indian J Pediatr 2015;82:737–44Google Scholar
14 Sancheti, M, Force, S. Endotracheal tube management and obstructed airway. Thorac Surg Clin 2015;25:279–88Google Scholar
15 Brofeldt, BT, Panacek, EA, Richards, JR. An easy cricothyrotomy approach: the rapid four-step technique. Acad Emerg Med 1996;3:1060–3Google Scholar
16 Crofts, JF, Mukuli, T, Murove, BT, Ngwenya, S, Mhlanga, S, Dube, M et al. Onsite training of doctors, midwives and nurses in obstetric emergencies, Zimbabwe. Bull World Health Organ 2015;93:347–51Google Scholar
17 Barakate, MS, Jensen, MJ, Hemli, JM, Graham, AR. Ludwig's angina: report of a case and review of management issues. Ann Otol Rhinol Laryngol 2001;110:453–6Google Scholar
18 Marcus, BJ, Kaplan, J, Collins, KA. A case of Ludwig angina: a case report and review of the literature. Am J Forensic Med Pathol 2008;29:255–9CrossRefGoogle ScholarPubMed
19 Rega, AJ, Aziz, SR, Ziccardi, VB. Microbiology and antibiotic sensitivities of head and neck space infections of odontogenic origin. J Oral Maxillofac Surg 2006;64:1377–80Google Scholar
20 Wong, CH, Wang, YS. The diagnosis of necrotizing fasciitis. Curr Opin Infect Dis 2005;18:101–6Google Scholar