title: Emergency cricothyrotomy--a systematic review.
abstract: BACKGROUND
  An emergency cricothyrotomy is the last-resort in most airway management protocols and is performed when it is not possible to intubate or ventilate a patient. This situation can rapidly prove fatal, making it important to identify the best method to establish a secure airway. We conducted a systematic review to identify whether there exists superiority between available commercial kits versus traditional surgical and needle techniques.
  
  
  METHODS
  Medline, EMBASE and other databases were searched for pertinent studies. The inclusion criteria included manikin, animal and human studies and there were no restrictions regarding the professional background of the person performing the procedure.
  
  
  RESULTS
  In total, 1,405 unique references were identified; 108 full text articles were retrieved; and 24 studies were included in the review. Studies comparing kits with one another or with various surgical and needle techniques were identified. The outcome measures included in this systematic review were success rate and time consumption. The investigators performing the studies had chosen unique combinations of starting and stopping points for time measurements, making comparisons between studies difficult and leading to many conflicting results. No single method was shown to be better than the others, but the size of the studies makes it impossible to draw firm conclusions.
  
  
  CONCLUSIONS
  The large majority of the studies were too small to demonstrate statistically significant differences, and the limited available evidence was of low or very low quality. That none of the techniques in these studies demonstrated better results than the others does not necessarily indicate that each is equally good, and these conclusions will likely change as new evidence becomes available.
authors.affiliation: Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Sofie
authors.initials: S
authors.lastname: Langvad
authors.forename: Per Kristian
authors.initials: PK
authors.lastname: Hyldmo
authors.forename: Anders Rostrup
authors.initials: AR
authors.lastname: Nakstad
authors.forename: Gunn Elisabeth
authors.initials: GE
authors.lastname: Vist
authors.forename: Marten
authors.initials: M
authors.lastname: Sandberg
mesh_terms: D058109:Airway Management / Q000379:methods*; D000818:Animals; D003413:Cricoid Cartilage / Q000601:surgery; D004632:Emergency Medical Services / Q000379:methods; D006801:Humans; D007817:Laryngeal Cartilages / Q000601:surgery*; D008348:Manikins; D016896:Treatment Outcome