title: Evaluation of Seldinger technique emergency cricothyroidotomy versus standard surgical cricothyroidotomy in 200 cadavers.
abstract: BACKGROUND
  Percutaneous cricothyroidotomy is a lifesaving procedure for airway obstruction in trauma victims who need airway establishment and cannot be intubated or in whom intubation has failed.
  
  
  METHODS
  The purpose of this study was to examine whether there is a training effect using Seldinger technique emergency cricothyroidotomy (group 1; Arndt Emergency Cricothyroidotomy Catheter Set; Cook Critical Care, Bloomington, IN) versus standard surgical cricothyroidotomy (group 2). Twenty emergency physicians performed five cricothyroidotomies with each method in a total of 200 human cadavers, comparing efficacy and safety (speed, success rate, and injuries).
  
  
  RESULTS
  Seven attempts in group 1 and six in group 2 had to be aborted. Time intervals from the start of the procedure to location of the cricothyroid membrane were not significantly different between the groups. However, time to tracheal puncture (P < 0.01) and time to first ventilation (P < 0.001) were significantly longer in group 2. No time effect could be observed in both groups. The airway was accurately placed into the trachea through the cricothyroid membrane in 88.2% (82 of 93) of the cadavers in group 1 and in 84.0% (79 of 94) in group 2 (not significant). No injuries were observed in group 1, whereas there were six punctures of the thyroid vessels in group 2 (P < 0.05).
  
  
  CONCLUSIONS
  With respect to time needed for the procedure, the participants performed Seldinger technique emergency cricothyroidotomy significantly faster as compared with standard surgical cricothyroidotomy. Even if no training effect had been observed, the authors believe that it is important to train residents in different methods of cricothyroidotomy in cadavers in addition to training in mannequins to achieve a higher level of efficacy in real-life situations. The shorter time to first ventilation and the fact that no injuries could be observed favor the Seldinger technique.
authors.affiliation: Department of Internal Medicine I, Intensive Care Unit, Medical University of Vienna, Austria.
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Schaumann
authors.forename: Veit
authors.initials: V
authors.lastname: Lorenz
authors.forename: Peter
authors.initials: P
authors.lastname: Schellongowski
authors.forename: Thomas
authors.initials: T
authors.lastname: Staudinger
authors.forename: Gottfried J
authors.initials: GJ
authors.lastname: Locker
authors.forename: Heinz
authors.initials: H
authors.lastname: Burgmann
authors.forename: Branko
authors.initials: B
authors.lastname: Pikula
authors.forename: Roland
authors.initials: R
authors.lastname: Hofbauer
authors.forename: Ernst
authors.initials: E
authors.lastname: Schuster
authors.forename: Michael
authors.initials: M
authors.lastname: Frass
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D002983:Clinical Competence; D003413:Cricoid Cartilage / Q000601:surgery*; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000033:anatomy & histology; D013594:Syringes; D013961:Thyroid Gland / Q000601:surgery*; D014132:Trachea