title: Surgical vs wire-guided cricothyroidotomy: a randomised crossover study of cuffed and uncuffed tracheal tube insertion.
abstract: Using an airway mannequin and artificial lung model, we compared surgical cricothyroidotomy with a 6.0-mm cuffed Portex tracheostomy tube with wire-guided cricothyroidotomy using a 5.0-mm cuffed Melker or 6.0-mm uncuffed Melker tube. The trial was carried out by 27 anaesthetists using a randomised, crossover design. Surgical cricothyroidotomy proved significantly faster (mean (SD) time to first breath 44.3 (12.5) s for Portex surgical, 87.2 (21.6) s for cuffed Melker, 87.8 (19.2) s for uncuffed Melker, p < 0.001). With a standardised ventilator model, the cuffed tubes provided more effective ventilation (mean (SD) tidal volume 446 (41) ml Portex, 436 (52) ml cuffed Melker, 19 (5) ml uncuffed Melker, p < 0.001). Fourteen of the participants preferred the wire-guided system. We conclude that, in this model, a cuffed device is preferable when cricothyroidotomy is needed. In addition, the surgical method is quicker than a wire-guided approach.
authors.affiliation: The Countess of Chester Hospital Foundation NHS Trust, UK.
authors.forename: L
authors.initials: L
authors.lastname: Sulaiman
authors.forename: S Q M
authors.initials: SQ
authors.lastname: Tighe
authors.forename: R A
authors.initials: RA
authors.lastname: Nelson
mesh_terms: D000402:Airway Obstruction / Q000628:therapy; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003413:Cricoid Cartilage / Q000601:surgery*; D018592:Cross-Over Studies; D004630:Emergencies; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D008348:Manikins; D008953:Models, Anatomic; D012121:Respiration, Artificial / Q000379:methods; D013957:Thyroid Cartilage / Q000601:surgery*; D014139:Tracheostomy / Q000295:instrumentation / Q000379:methods*