title: Emergency cricothyroidotomy performed by inexperienced clinicians--surgical technique versus indicator-guided puncture technique.
abstract: BACKGROUND
  To improve the ease and safety of cricothyroidotomy especially in the hand of the inexperienced, new instruments have been developed. In this study, we compared a new indicator-guided puncture technique (PCK) with standard surgical technique (ST) regarding success rate, performance time and complications.
  
  
  METHODS
  Cricothyroidotomy in 30 human cadavers performed by 30 first year anaesthesia residents. The set chosen for use was randomised: PCK-technique (n=15) and ST (n=15). Success rates, insertion times and complications were compared. Traumatic lesions were anatomically confirmed after dissection.
  
  
  RESULTS
  The ST-group had a higher success rate (100% vs 67%; p=0.04). There was no difference in time taken to complete the procedure (PCK 82 s. vs ST 95 s.; p=0.89). There was a higher complication rate in the PCK-group (67% vs 13%; p=0.04). Most frequent complication in the PCK-group was injury to the posterior tracheal wall (n=8), penetration to the oesophageal lumen (n=4) and injury to the thyroid and/or cricoid cartilage (n=5). In the ST-group in only 2 cases minor complications were observed (small vessel injury).
  
  
  CONCLUSIONS
  In this human cadaver study the PCK technique produced more major complications and more failures than the ST. In the hand of the inexperienced operator the standard surgical approach seems to be a safe procedure, which can successfully be performed within an adequate time. The PCK technique cannot be recommended for inexperienced operators.
authors: Department of Anaesthesiology and Intensive Care Medicine-Section Emergency, Medicine/Federal Armed Forces Medical Centre, Ulm, Germany. matthias.helm@extern.uni-ulm.de
authors: Matthias
authors: M
authors: Helm
authors: Björn
authors: B
authors: Hossfeld
authors: Christian
authors: C
authors: Jost
authors: Lorenz
authors: L
authors: Lampl
authors: Tobias
authors: T
authors: Böckers
mesh_terms: D000328:Adult; D000776:Anesthesiology / Q000193:education; D002102:Cadaver; D002983:Clinical Competence; D003413:Cricoid Cartilage / Q000601:surgery*; D004503:Education, Medical, Graduate; D004638:Emergency Treatment / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D004867:Equipment Design; D005858:Germany; D006801:Humans; D007396:Internship and Residency; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D008887:Military Medicine / Q000193:education; D014140:Tracheotomy / Q000295:instrumentation / Q000379:methods*