The Annals of Thoracic Surgery, Vol 39, 353-354, Copyright © 1985 by The Society of Thoracic Surgeons
Cricothyroidotomy for prolonged ventilatory support after cardiac operations
JV O'Connor, K Reddy, MA Ergin and RB Griepp
Forty-nine patients required prolonged ventilatory support after cardiac
operations. Cricothyroidotomy was used routinely in these patients after
approximately 7 days of endotracheal intubation. There were no infections
of the median sternotomy wounds despite frequent colonization of the stoma.
The only immediate complication was mild stomal bleeding in a patient
taking anticoagulants. Nineteen patients (39%) died of underlying disease.
The average duration of cricothyroidotomy was 59 days (range, 3 to 270
days). Cannulas were successfully removed in all survivors after an average
of 38 days (range, 6 to 187 days). All of the patients were followed by
personal interview, telephone contact, or contact with the referring
physician. The average length of follow-up was 17 months (range, 2 to 50
months). All symptomatic patients were evaluated by laryngoscopy and
bronchoscopy. One patient required endoscopic removal of granulation tissue
from the stomal site; 2 others required tracheal resection for stenosis at
the balloon site. There were no instances of subglottic stenosis. There
were 4 late deaths, none of which was related to the cricothyroidotomy.
Based on these findings, we suggest that cricothyroidotomy, with its low
complication rate, is the procedure of choice for patients requiring
prolonged mechanical ventilation after cardiac operations.
