# Role of Ultrasound in Tracheotomy and Cricothyrotomy: A Research Study of Midline Cervical Vasculature in Healthy Individuals

## TL;DR

This study shows that ultrasound can detect midline neck blood vessels in healthy people, suggesting it should be used more often during airway procedures to prevent injuries.

## Contribution

The study provides empirical evidence on the prevalence of midline cervical vasculature in healthy individuals and advocates for routine ultrasound use in airway procedures.

## Key findings

- Midline vascular structures were found in 28.7% of healthy individuals using ultrasound.
- Most vessels were located at the thyroid isthmus level (22.5%).
- No consistent guidelines recommend routine ultrasound use for tracheotomy or cricothyrotomy.

## Abstract

Introduction

Tracheotomy and cricothyrotomy are life-saving airway interventions that carry a risk due to the presence of midline vascular structures in the anterior neck. Injury to these structures during blind landmark-based procedures can lead to serious complications. Ultrasound (US) is a non-invasive, real-time imaging modality that enables direct visualization of cervical anatomy and vascular variants. Despite its advantages, its routine use is not yet standardized in clinical protocols. This study aims to evaluate the prevalence of midline vasculature using US in healthy individuals and to review current guidelines regarding US use in airway access. The aim of the study is to assess the prevalence of midline cervical vasculature using US in healthy adults and to review national and international guidelines on US use in tracheotomy and cricothyrotomy procedures.

Methods

This cross-sectional observational study included 80 healthy volunteers in the age range of 18 to 49 years. High-resolution US scans were performed at three anatomical levels: the inferior border of the thyroid cartilage, the superior border of the cricoid cartilage, and the inferior edge of the thyroid isthmus. The presence of midline vascular structures was recorded. A concurrent review of airway management guidelines (American Society of Anesthesiologists, Difficult Airway Society, Royal College of Anaesthetists, and others) was also undertaken.

Results

Midline vascular structures were identified in 23 participants (28.7%). At specific anatomical levels, 18 participants (22.5%) had vessels at the thyroid isthmus, three participants (3.8%) had at the cricoid cartilage, and two participants (2.5%) had at the thyroid cartilage. No significant association was found between vascular presence and demographic factors such as sex, BMI, or ethnicity, with a p-value of 0.6 (Gender) and 0.9 (Ethnicity). Guideline review revealed no consistent recommendations for routine US use in tracheotomy or cricothyrotomy.

Conclusion

The US detected significant vascular structures in the midline neck, particularly at the thyroid isthmus level, in a substantial portion of healthy individuals. These findings support integrating the US into standard airway management protocols to enhance safety and accuracy.