Cricothyrotomy and Tracheostomy for Airway Access: A Systematic Review and Meta-Analysis

• DOI: https://doi.org/10.22533/at.ed.8781126230112

• Palavras-chave: Cricotireotomia; Traqueostomia; Manejo das Vias Aéreas; Vias Aéreas de Emergência; Revisão Sistemática

• Keywords: Cricothyrotomy; Tracheostomy; Airway Management; Emergency Airway; Systematic Review

• Abstract: Background: Cricothyrotomy and tracheostomy are established surgical airway procedures used to secure ventilation in emergency and elective settings. Variability in reported clinical outcomes across studies warrants systematic examination to better characterize rates of procedural success, complications, and mortality. Objectives: To evaluate the clinical outcomes of cricothyrotomy and tracheostomy by synthesizing available evidence through single-arm meta-analyses, estimating pooled rates of procedural success, complications, and mortality across published studies. Methods: Statistical analyses were performed in R (version 4.5.0) using the “meta” and “metafor” packages to conduct single-arm meta-analyses of proportions. Pooled estimates were calculated using a random-effects model (DerSimonian-Laird) with Freeman-Tukey transformation and reported with 95% confidence intervals (CI). Heterogeneity was assessed using Cochran’s Q and I² statistics. Results: Subglottic stenosis or edema occurred in 2.01% of patients undergoing cricothyrotomy (95% CI, 0.28-4.72; I² = 0%). In studies of tracheostomy, the pooled incidence was 0.02% (95% CI, 0.00-0.61; I² = 10%). Bleeding was observed in 5.14% of patients undergoing cricothyrotomy (95% CI, 1.99-9.35; I² = 23%) and in 6.77% of patients undergoing tracheostomy (95% CI, 3.93-10.20). Infection occurred in 1.38% of patients undergoing cricothyrotomy (95% CI, 0.00-4.47; I² = 7%) and in 4.87% of patients undergoing tracheostomy (95% CI, 1.56-9.52; I² = 88%). Conclusions: Cricothyrotomy and tracheostomy were associated with low pooled rates of major complications across studies. Subglottic stenosis or edema was uncommon overall but occurred more frequently in reports of cricothyrotomy, whereas bleeding and infection were observed in both procedures. These findings provide pooled estimates that may inform clinical decision-making and highlight the need for further comparative studies.