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Emergency cricothyrotomy during the COVID-19 pandemic: how to suppress aerosolization
  1. Nabil Issa1,
  2. Whitney E Liddy2,
  3. Sandeep Samant2,
  4. David B Conley2,
  5. Robert C Kern2,
  6. Eric S Hungness1,
  7. Jeffrey H Barsuk3
  1. 1Departments of Surgery and Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  2. 2Department of Ear, Nose and Throat, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  3. 3Departments of Medicine and Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
  1. Correspondence to Dr Nabil Issa, Departments of Surgery and Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; Nabil.Issa{at}


Background Cricothyrotomy is associated with significant aerosolization that increases the potential risk of infection among healthcare providers. It is important to identify simple yet effective methods to suppress aerosolization and improve the safety of healthcare providers.

Methods 5 ear, nose and throat and general surgeons used a locally developed hybrid cricothyrotomy simulator with a porcine trachea to test three draping methods to suppress aerosolization during the procedure: an X-ray cassette drape, dry operating room (OR) towels and wet OR towels. The three methods were judged based on three categories: effectiveness of suppression, availability in all healthcare systems and ease of handling.

Results All five surgeons performed the procedure independently using each of the three suppression methods. The wet OR towel drape was found to be an effective method to suppress aerosolization, and it did not hinder the surgeons from performing the procedure accurately. This finding was confirmed by using an atomized fluorescein dye injection into the porcine trachea, representing aerosolized material while performing the procedure.

Conclusions We present a novel intervention using wet towels to suppress aerosolization during cricothyrotomy. Wet towels are cheap and readily available within any healthcare setting regardless of the financial resources available.

  • airway management
  • critical care
  • emergency treatment
  • intubation

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  • NI and JHB are joint first authors.

  • NI and JHB contributed equally.

  • Collaborators Instructional Design and Development at Northwestern: Kim H Le Mezo; Deon Griffin; James B Brucker for creating and editing the video.

  • Contributors All seven authors contributed to the concept, design, drafting and revision of the manuscript. NI, WEL, SS and DBC provided the conception and design. NI and JHB prepared the initial draft for the manuscript. All authors contributed to interpretation of data and critical revision of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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