Comparison of 2 cricothyrotomy techniques: standard method versus rapid 4-step technique.
OBJECTIVE
To compare the success rate, complication rate and time required for the rapid 4-step technique versus the standard technique for cricothyrotomy.


METHODS
We conducted a prospective, randomized crossover study. Twenty-seven emergency medicine interns, 1 junior medicine resident, and 4 senior medical students, without prior cricothyrotomy experience, were randomly divided into 2 groups. Group 1 was initially instructed in and then performed the standard technique; group 2 was initially instructed in and then performed the rapid 4-step technique. Each group was then instructed in and performed the alternate method. Cricothyrotomies were performed on preserved human cadavers.


RESULTS
A surgical airway was established in 28 of 32 attempts with the use of the rapid 4-step technique (88%); the average time elapsed before tube placement was 43 seconds. Thirty of 32 attempts involving the standard technique (94%) were successful; the average time to tube placement was 134 seconds (95% confidence interval for a difference of 91 seconds, 63 to 119; P < .001). Complications were identified in 12 attempts involving the standard technique (38%; 1 considered major) and in 12 involving the rapid four-step technique (38%; 3 considered major). The incidence of major complications was 6% higher for the rapid 4-step technique (95% confidence interval, -9% to 21%).


CONCLUSIONS
In a group of inexperienced subjects working on a preserved human cadaver model, the rapid 4-step technique for cricothyrotomy was performed in about one third the time required for performance of the standard technique. This finding was both clinically and statistically significant. Although the 2 techniques had similar success and complication rates, we noted a trend toward more severe complications in the rapid 4-step technique.
Holmes
J F
JF
Division of Emergency Medicine, University of California, Davis, Medical Center, Sacramento, USA. jfholmes@ucdavis.edu
Panacek
E A
EA
Sakles
J C
JC
Brofeldt
B T
BT
D003413:Cricoid Cartilage / Q000293:injuries / Q000601:surgery*; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D011446:Prospective Studies; D013337:Students, Medical; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000379:methods; D013957:Thyroid Cartilage / Q000293:injuries / Q000601:surgery*; D014140:Tracheotomy