Conducting Tracheostomies under Local Anesthesia in the Emergency Room: An Analytical Literature Review

Abstract

Tracheostomy continues to be a lifesaving technique that is frequently performed in many emergency settings. It has been believed to help people with mechanical ventilation, and respiratory failure, and for clearing secretions rapidly where they could not otherwise be cleared due to the immobility and restricted activity of the patient. As a rule of thumb, tracheostomies are commonly performed on patients with a low GCS and for those in whom the prognosis seems to be very predictable in a negative sense. When tracheostomy is done on such patients, either through the open surgical or percutaneous method, it has been seen to bring about a change in their condition slowly. Some patients have also been brought back from the critical care units or ICUs, whereas some did not improve at all. Therefore, it is suitable to say that it is all dependent upon the patient’s underlying condition and ruling prognostic factors as well. This review deals with performing tracheostomy under local anesthesia in the emergency department. This type of tracheostomy is usually performed in the emergency room under certain situations when it becomes necessary to take urgent steps for saving the patient’s life. Usually, it is a ‘do or die’ type of situation for the patients, where delaying any form of intervention could lead to deadly consequences. The aim of this paper is to review the efficacy and success rates procedure of these tracheotomies, especially under those situations where they were the only life-saving hope left for the patient to survive, and that too, being a subjective hope. It has been a matter of common observation over all these years that doing tracheostomy within the right time interval could indeed help improve the prognosis of the patient and even improve the GCS score in some of the critically ill patients. This review will serve as an explanatory guide for such patients.