Emergency Needle Tracheostomy in Unanticipated Difficult Intubation Case with Undetected History of Tracheobronchial Injury Patient – A Case Report

Abstract

Background: An emergency situation where intubation and/or ventilation are unable to perform is rare but life-threatening. Within Can't Intubate, Can't Oxygenate algorithm, the emergency cricothyrotomy is the final step. Yet, it can be difficult in some cases and require alternative invasive airway strategies.

Case: We present an unusual case of a 22-year-old male, who were taken to the emergency with severe hypoxemia and respiratory distress. Despite optimal vocal cord visualization, the attempts to intubate endotracheal, supraglottic airway placement, and face-mask ventilation were failed, resulting in a CICO situation. Needle cricothyrotomy was unsuccessful. Emergency needle tracheostomy with a 16G enabled the return of spontaneous circulation. The patient’s definitive airway control was achieved with rapid percutaneous dilatational tracheostomy. Later, subsequent imaging revelated undetected tracheobronchial injury and experienced 60% trachea narrowing.

Conclusion: This case demonstrates that the needle tracheostomy is a viable and effective technique in emergencies to establish definitive airway access.