title: Cricothyroidotomy: comparison of three different techniques on a porcine airway.
abstract: We compared three different cricothyroidotomy techniques on a cadaveric porcine airway model to determine the most rapid, successful and safe method in emergency situations. In this observational comparative bench-test, surgical or scalpel cricothyroidotomy (ST), Cook Melker Cricothyrotomy Kit (CM) and Portex Cricothyroidotomy Kit (PCK) were evaluated. After a familiarisation program, four operators performed five procedures using each of the techniques. A dissected pig airway was housed in an airway training manikin. Time to successful completion of the procedure, complications and anatomical variations in the pig larynx were recorded. A patent airway was established in 20 of 20 (100%) attempts with CM technique, 11 of 20 (55%) with ST and six of 20 (30%) with PCK technique. The CM technique was associated with a higher success rate (P <0.001). There was no significant difference (P=0.4) in the median time (interquartile range) taken to achieve a patent airway; CM 50 seconds (40 to 57), ST 47 seconds (41 to 55) and PCK 63 seconds (41 to 150). There was a higher rate of posterior tracheal wall injury with the PCK technique (n=11) and ST technique (n=5). No complications were observed with CM technique. There were no significant anatomical variations in the pig larynxes. We conclude that the CM technique is safe, rapid and has a significantly higher success rate in achieving an artificial airway in this airway model. Overall, all the participants in our study preferred to use this kit in an emergency situation.
authors.affiliation: Intensive Care Unit, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: V
authors.initials: V
authors.lastname: Mariappa
authors.forename: E
authors.initials: E
authors.lastname: Stachowski
authors.forename: M
authors.initials: M
authors.lastname: Balik
authors.forename: P
authors.initials: P
authors.lastname: Clark
authors.forename: V
authors.initials: V
authors.lastname: Nayyar
mesh_terms: D000818:Animals; D003413:Cricoid Cartilage / Q000601:surgery*; D004638:Emergency Treatment / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D004867:Equipment Design; D008348:Manikins; D023421:Models, Animal; D011183:Postoperative Complications / Q000209:etiology; D013552:Swine; D013997:Time Factors