NEJM recently published an interesting review article on upper airway obstruction. This podcast was spurred by a rantorial on twitter by Farkas regarding the article:
this fresh review article in NEJM on acute upper airway obstruction is the most horrifically wrong & dangerous piece of literature I've encountered in a while 😳 (#rantorial 1/6)https://t.co/sDCY53cWkn pic.twitter.com/2FdCly2b0C
— 𝙟𝙤𝙨𝙝 𝙛𝙖𝙧𝙠𝙖𝙨 (he/him) 💊 (@PulmCrit) November 14, 2019
I took a look–and it was indeed bad…
Here is the Article:
Eskander et al. Acute Upper Airway Obstruction
Some Additional References
Here is the review article on which some of the flawed messages of the NEJM piece are based:
- Cricothyrotomy versus Trachetomy: An Otolaryngologist's Perspective. Laryngoscope. 1988 Feb;98(2):131-5.
These two pieces from the ENT and OMFS literature correct these errors:
- Cricothyrotomy: When, Why and Why Not: Am J Otolaryng 2000;21(3):195
- Elective Surgical Cricothyroidotomy in Oral and Maxillofacial Surgery Br J Oral Max Surg 2013;51:779
Updates:
- Best Practices for Emerg Surg Airway (Laryng Invest Otolaryng 2019;4:602)
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I’m glad to see others had the same reaction I did. The myth of needing to urgently convert crics to trachs seems impossible to slay, among others.