title: A laboratory comparison of emergency percutaneous and surgical cricothyrotomy by prehospital personnel.
abstract: OBJECTIVE
  To compare the speeds and success rates of placement for percutaneous cricothyrotomy versus surgical or open cricothyrotomy.
  
  
  METHODS
  Twenty-two paramedics (mean 9.7 years of experience), with training in both methods, were timed using a pig trachea in a crossover model. An emergency physician performed timing and documentation of success; timing commenced after the equipment was ready and the membrane was identified. Paramedics were randomly assigned by a coin toss to start in either group. All were actively employed by a municipal third-service emergency medical services (EMS) agency. Paramedics who did not complete one of the methods correctly were excluded from speed analysis. Data were analyzed using descriptive statistics, a t-test of paired samples, and confidence intervals for matched samples.
  
  
  RESULTS
  Placement of a surgical cricothyrotomy was significantly faster (mean 28 seconds, range 10-78 seconds) than the percutaneous method (mean 123 seconds, range 58-257 seconds) (p < 0.001). Mean difference between the 20 matched percutaneous versus surgical pairs was 93.75 seconds (95% CI 72.3, 115.2). The surgical route had a 100% success rate at obtaining airway control, whereas the percutaneous method had a 90.9% success rate (p = 0.1).
  
  
  CONCLUSIONS
  In an animal model, surgical cricothyrotomy appeared to be a preferable method for establishing a definitive airway over the percutaneous method. Further research is required to define the optimal approach in the prehospital setting for the invasive airway.
authors.affiliation: Boston Medical Center and Boston Emergency Medical Services, Boston, Massachusetts 02118-2525, USA. keane_m@bostonems.org
authors.forename: Michelle Fischer
authors.initials: MF
authors.lastname: Keane
authors.forename: Kathryn H
authors.initials: KH
authors.lastname: Brinsfield
authors.forename: K Sophia
authors.initials: KS
authors.lastname: Dyer
authors.forename: Simon
authors.initials: S
authors.lastname: Roy
authors.forename: Daniel
authors.initials: D
authors.lastname: White
mesh_terms: D000328:Adult; D000818:Animals; D018592:Cross-Over Studies; D004632:Emergency Medical Services; D004634:Emergency Medical Technicians; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013552:Swine; D013997:Time Factors; D014140:Tracheotomy / Q000379:methods*