Emergency cricothyrotomy-a comparative study of different techniques in human cadavers.
BACKGROUND
Emergency cricothyrotomy is the final lifesaving option in "cannot intubate-cannot ventilate" situations. Fast, efficient and safe management is indispensable to reestablish oxygenation, thus the quickest, most reliable and safest technique should be used. Several cricothyrotomy techniques exist, which can be grouped into two categories: anatomical-surgical and puncture.


METHODS
We studied success rate, tracheal tube insertion time and complications of different techniques, including a novel cricothyrotomy scissors technique in human cadavers. Sixty-three inexperienced health care providers were randomly assigned to apply either an anatomical-surgical technique (standard surgical technique, n=18; novel cricothyrotomy scissors technique, n=14) or a puncture technique (catheter-over-needle technique, n=17; wire-guided technique, n=14).


RESULTS
Airway access was almost always successful with the anatomical-surgical techniques (success rate in standard surgical group 94%, scissors group 100%). In contrast, the success rate was smaller (p<0.05) with the puncture techniques (catheter-over-needle group 82%, wire-guided technique 71%). Tracheal tube insertion time was faster overall (p<0.05) with anatomical-surgical techniques (standard surgical 78s [54-135], novel cricothyrotomy scissors technique 60s [42-82]; median [IQR]) than with puncture techniques (catheter-over-needle technique 74s [48-145], wire-guided technique 135s [116-307]). We observed fewer complications with anatomical-surgical techniques than with puncture techniques (p<0.001).


CONCLUSIONS
In inexperienced health care personnel, anatomical-surgical techniques showed a higher success rate, a faster tracheal tube insertion time and a lower complication rate compared with puncture techniques, suggesting that they may be the techniques of choice in emergencies.
Schober
Patrick
P
Department of Anesthesiology, VU University Medical Center, 1007 MB, Amsterdam, The Netherlands. P.Schober@vumc.nl
Hegemann
Martina C
MC
Schwarte
Lothar A
LA
Loer
Stephan A
SA
Noetges
Peter
P
D000328:Adult; D000369:Aged, 80 and over; D002102:Cadaver; D002983:Clinical Competence; D003413:Cricoid Cartilage / Q000601:surgery*; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D013337:Students, Medical; D013525:Surgical Instruments; D013997:Time Factors; D014140:Tracheotomy / Q000379:methods*; D055815:Young Adult