title: A comparison of a new indicator-guided with a conventional wire-guided percutaneous cricothyroidotomy device in mannequins.
abstract: BACKGROUND
  Percutaneous cricothyroidotomy may be a life-saving procedure in cannot intubate-cannot ventilate situations. In this study we compared the insertion times of a new indicator-guided cricothyroidotomy device and a wire-guided device in mannequins.
  
  
  METHODS
  This study was a crossover trial comparing the insertion times and success rates of an indicator-guided tube-over-needle device and a wire-guided cricothyroidotomy device in a mannequin. After an audiovisual training session, 64 anesthesiologists performed five cricothyroidotomies with each of the two devices. Successful insertion was defined as insertion of a device into the correct anatomic location. The insertion times and success rates between the two techniques for the five attempts were compared using repeated measures ANOVA, paired t-test, and chi(2) analyses.
  
  
  RESULTS
  Insertion times were faster (32.6 +/- 14.9 s vs 42.3 +/- 12.5 s, P < 0.001) while success rates were similar (95% vs 93.1%) with the indicator-guided device when compared with the wire-guided device. For both devices, performance improved with repeated attempts. Four insertion attempts (1.3%) were positioned anterior or posterior to the trachea lumen with the indicator-guided device compared to none with the wire-guided device (P = 0.12) Subjectively, more participants chose to use the wire-guided than the indicator-guided device (59% vs 31%, P < 0.001) in a clinical emergency situation.
  
  
  CONCLUSIONS
  In a mannequin model, cricothyroidotomy insertion times were faster for the indicator-guided technique than for the wire-guided technique, but success rates were similar. Subjectively, more participants chose to use the wire-guided device in a clinical emergency situation.
authors.affiliation: Department of Anesthesia, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Assmann
authors.forename: David T
authors.initials: DT
authors.lastname: Wong
authors.forename: Eduardo
authors.initials: E
authors.lastname: Morales
mesh_terms: D000328:Adult; D003413:Cricoid Cartilage; D018592:Cross-Over Studies; D006801:Humans; D007440:Intubation / Q000295:instrumentation* / Q000379:methods*; D008348:Manikins; D008875:Middle Aged; D013957:Thyroid Cartilage