Airway Complication of AnesthesiaNCT04138121
Impact of Change of Head and Neck Position on Cricothyroid Membrane Localization and Membrane Height in Parturient Patients
A study testing Ultrasound in people with Airway Complication of Anesthesia, run by Samuel Lunenfeld Research Institute, Mount Sinai Hospital at 1 site in Canada.
Trial summary
The cricothyroid membrane acts a route through which the upper airway can be accessed in order to provide oxygen and ventilation to patients. The need to provide oxygen and ventilation to patients is essential particularly under general anesthesia, where patients may lose the ability to breathe for themselves. Read more about this study
- Who is it for?
- Ages 18 years and older, women onlyHealthy volunteers can take part
- Conditions the study is for
- Airway Complication of Anesthesia
- What is being tested?
- Ultrasound
- Type of treatment
- Medical device
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 50 participants
- Where
- 1 siteCanada
- Study dates
- 4 Nov 2019to 20 Dec 2019
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- Women only
- Healthy volunteers accepted
- Adult, Older adult
Who may be able to join
- Pregnant patients in third trimester (>28/40 weeks)
- Ability to understand the rationale of the study assessments and to provide signed consent.
Who cannot join
- Neck arthritis
- Cervical stenosis
- Known cervical degenerative disc disease
- Rheumatoid Arthritis
- Any restriction of neck movement
- Upper limb neurology
Show all 9Show fewer
- Patient refusal
- Non pregnant patients
- Pregnant patients less than 28 weeks pregnant
Trial locations and contacts
1 site in 1 country.
About this study
Official title: Impact of Change of Head and Neck Position on Cricothyroid Membrane Localization and Membrane Height in Parturient Patients: an Observational Study
The cricothyroid membrane acts a route through which the upper airway can be accessed in order to provide oxygen and ventilation to patients. The need to provide oxygen and ventilation to patients is essential particularly under general anesthesia, where patients may lose the ability to breathe for themselves. Access through this membrane to provide oxygen and ventilation is critical in emergency situations where other traditional means to access the airway (e.g through endotracheal ventilation, supraglottic airway devices or face mask ventilation) have failed. It is known that due to the physiological changes of pregnancy, the upper airway of the body undergoes changes that can make accessing the airway through traditional means more difficult. Ultrasound is becoming increasingly popular due to its ability to identify the cricothyroid membrane, to improve success in accessing the airway through the cricothyroid membrane. Studies to date in non pregnant adults have shown that alterations in the head and neck position can alter the position and size of the cricothyroid membrane. No study to date however has looked at how changing the position of the head and neck effects the position and size of the cricothyroid membrane in pregnant patients. It is important to study these changes in the pregnant population, given the physiological changes of pregnancy that make accessing the airway through traditional methods more difficult in non pregnant patients. The investigators hypothesize that in pregnant patients in the third trimester, that changing the head from the neutral to maximally extended neck position will alter the position of the cricothyroid membrane in relation to anatomical skin markings between positions. The investigators also hypothesize that in pregnant patients in the third trimester that changing the head from the neutral to maximally extended neck position will increase the size of the cricothyroid membrane. The investigatorsalso aim to determine at what position in the neck a theoretical standardized incision will allow access to the cricothyroid membrane.
Read the detailed description
This is an observational study.
Participants:
- One of two anesthesiologists trained in cricothyroid membrane ultrasound scanning technique in pregnant population (study investigators)
- Subjects to be assessed: pregnant patients in their third trimester on the labor and delivery floor comfortable enough to take part in the study
Two anesthesiologists will undergo ultrasound imaging training by an expert staff anesthesiologist whom is already trained in the procedure. As per previous published evidence on this, the investigator will need to correctly identify the location of cricothyroid membrane and its height in 15 volunteers. This will constitute the standardized training component of the study.
Upon admission to the Labor and Delivery floor, women will be further explained the protocol and asked to sign the consent form. Then, they will have the cricothyroid membrane assessed, as per description above, and quantitative assessment will be performed. Firstly, quantitative assessment of the height of the cricothyroid membrane will be performed in the supine position (with left uterine displacement) with the neck in the neutral position. The central point of the cricothyroid membrane will be marked using a removable skin ink marker. The patient will then be asked to fully their neck. The change in distance of the midpoint of the cricothyroid membrane from the neutral head and neck position to fully extended positioned will be performed, as will the change in height of the cricothyroid membrane between the two positions.
Quantitative assessment for change in central cricothyroid membrane distance will be done with measuring central points marked on the patients neck with skin marker ink. Quantitative assessment of change in cricoid thyroid membrane will be conducted using caliper measuring software build into the ultrasound machinery. Finally, the investigators will establish the starting distance above the sternal notch over which a theoretical 8cm incision in the neck which will overlie the cricothyroid membrane. This will be done by measuring the distance above the sternal notch with a surgical measuring ruler.
- Conditions
- Airway Complication of Anesthesia
- Being tested
- Ultrasound
- Keywords
- cricothyroid membrane, pregnancy, ultrasound
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
UltrasoundDevice
Ultrasound scan of the cricothyroid membrane
| Study group | Role | What they receive |
|---|---|---|
| Ultrasound | Experimental | Ultrasound measurements of the cricothyroid membrane. Receives: Device: Ultrasound |
What is being measured
The primary outcome is the main question the study is designed to answer.
Cricothyroid membrane position change
To measure the distance the center of the cricothyroid membrane changes position on ultrasound between neutral and maximal neck extension in third trimester patients.
Measured: 30 minutes
Secondary outcomes (2)
Cricothyroid membrane size change
To measure the distance that the size of the cricothyroid membrane changes position on ultrasound between neutral and maximal neck extension in third trimester patients.
Measured: 30 minutes
Distance above sternal notch
The starting distance above the sternal notch in the neck over which an 8cm incision in the neck should overlie the cricothyroid membrane
Measured: 30 minutes
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted24 Oct 2019
- Study start4 Nov 2019
- Primary completion20 Dec 2019
- Study completion20 Dec 2019
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Airway Complication of AnesthesiaStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Prevention
- Allocation
- Not applicable
- Intervention model
- Single group
- Masking
- None (open label)
- Enrolment
- 50 participants (actual)
Sponsor and investigators
- Lead sponsor
- Samuel Lunenfeld Research Institute, Mount Sinai Hospital
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Naveed Siddiqui, MD, Principal investigator, MOUNT SINAI HOSPITAL
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT04138121
- Sponsor's protocol ID
- 19-05
- Status last verified
- Sep 2020
- First submitted
- 22 Oct 2019
- Last updated
- 11 Sep 2020
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Study at a glance
From the registry record, last updated by the sponsor on 11 Sep 2020. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Impact of Change of Head and Neck Position on Cricothyroid Membrane Localization and Membrane Height in Parturient Patients: an Observational Study
- ClinicalTrials.gov ID
- NCT04138121
- Acronym / sponsor ID
- 19-05
- Conditions
- Airway Complication of Anesthesia
- Keywords
- cricothyroid membrane, pregnancy, ultrasound
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 50 participants (actual)
- Lead sponsor
- Samuel Lunenfeld Research Institute, Mount Sinai HospitalUniversity, hospital or other
- Study start
- 4 Nov 2019 (actual)
- Primary completion
- 20 Dec 2019 (actual)
- Study completion
- 20 Dec 2019 (actual)
- First posted
- 24 Oct 2019 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The cricothyroid membrane acts a route through which the upper airway can be accessed in order to provide oxygen and ventilation to patients. The need to provide oxygen and ventilation to patients is essential particularly under general anesthesia, where patients may lose the ability to breathe for themselves. Access through this membrane to provide oxygen and ventilation is critical in emergency situations where other traditional means to access the airway (e.g through endotracheal ventilation, supraglottic airway devices or face mask ventilation) have failed. It is known that due to the physiological changes of pregnancy, the upper airway of the body undergoes changes that can make accessing the airway through traditional means more difficult. Ultrasound is becoming increasingly popular due to its ability to identify the cricothyroid membrane, to improve success in accessing the airway through the cricothyroid membrane. Studies to date in non pregnant adults have shown that alterations in the head and neck position can alter the position and size of the cricothyroid membrane. No study to date however has looked at how changing the position of the head and neck effects the position and size of the cricothyroid membrane in pregnant patients. It is important to study these changes in the pregnant population, given the physiological changes of pregnancy that make accessing the airway through traditional methods more difficult in non pregnant patients. The investigators hypothesize that in pregnant patients in the third trimester, that changing the head from the neutral to maximally extended neck position will alter the position of the cricothyroid membrane in relation to anatomical skin markings between positions. The investigators also hypothesize that in pregnant patients in the third trimester that changing the head from the neutral to maximally extended neck position will increase the size of the cricothyroid membrane. The investigatorsalso aim to determine at what position in the neck a theoretical standardized incision will allow access to the cricothyroid membrane.
Detailed description
This is an observational study.
Participants:
- One of two anesthesiologists trained in cricothyroid membrane ultrasound scanning technique in pregnant population (study investigators)
- Subjects to be assessed: pregnant patients in their third trimester on the labor and delivery floor comfortable enough to take part in the study
Two anesthesiologists will undergo ultrasound imaging training by an expert staff anesthesiologist whom is already trained in the procedure. As per previous published evidence on this, the investigator will need to correctly identify the location of cricothyroid membrane and its height in 15 volunteers. This will constitute the standardized training component of the study.
Upon admission to the Labor and Delivery floor, women will be further explained the protocol and asked to sign the consent form. Then, they will have the cricothyroid membrane assessed, as per description above, and quantitative assessment will be performed. Firstly, quantitative assessment of the height of the cricothyroid membrane will be performed in the supine position (with left uterine displacement) with the neck in the neutral position. The central point of the cricothyroid membrane will be marked using a removable skin ink marker. The patient will then be asked to fully their neck. The change in distance of the midpoint of the cricothyroid membrane from the neutral head and neck position to fully extended positioned will be performed, as will the change in height of the cricothyroid membrane between the two positions.
Quantitative assessment for change in central cricothyroid membrane distance will be done with measuring central points marked on the patients neck with skin marker ink. Quantitative assessment of change in cricoid thyroid membrane will be conducted using caliper measuring software build into the ultrasound machinery. Finally, the investigators will establish the starting distance above the sternal notch over which a theoretical 8cm incision in the neck which will overlie the cricothyroid membrane. This will be done by measuring the distance above the sternal notch with a surgical measuring ruler.
Study design
- Primary purpose
- Prevention
- Allocation
- Not applicable
- Intervention model
- Single group
- Masking
- None (open label)
- Number of arms
- 1
| Arm | Type | Receives |
|---|---|---|
| Ultrasound | Experimental | Device: UltrasoundUltrasound measurements of the cricothyroid membrane. |
Who may qualify
- Ages
- 18 years and older
- Sex
- Female only
- Healthy volunteers
- Accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (2 listed)
- Pregnant patients in third trimester (>28/40 weeks)
- Ability to understand the rationale of the study assessments and to provide signed consent.
Key exclusion criteria (9 listed)
- Neck arthritis
- Cervical stenosis
- Known cervical degenerative disc disease
- Rheumatoid Arthritis
- Any restriction of neck movement
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| UltrasoundUltrasound scan of the cricothyroid membrane | Device | Ultrasound |
Primary outcome
Cricothyroid membrane position change
Time frame: 30 minutes
To measure the distance the center of the cricothyroid membrane changes position on ultrasound between neutral and maximal neck extension in third trimester patients.
2 secondary outcomes
Cricothyroid membrane size change
Time frame: 30 minutes
Distance above sternal notch
Time frame: 30 minutes
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 11 Sep 2020.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Naveed Siddiqui, MD principal investigator
MOUNT SINAI HOSPITAL
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Ultrasound in people with Airway Complication of Anesthesia, run by Samuel Lunenfeld Research Institute, Mount Sinai Hospital at 1 site in Canada.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 2 inclusion and 9 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 11 Sep 2020. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Canada. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Cricothyroid membrane position change (time frame: 30 minutes). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 11 Sep 2020.