title: Emergent surgical airway: comparison of the three-step method and conventional cricothyroidotomy utilizing high-fidelity simulation.
abstract: BACKGROUND
  Surgical airway creation has a high potential for disaster. Conventional methods can be cumbersome and require special instruments. A simple method utilizing three steps and readily available equipment exists, but has yet to be adequately tested.
  
  
  OBJECTIVE
  Our objective was to compare conventional cricothyroidotomy with the three-step method utilizing high-fidelity simulation.
  
  
  METHODS
  Utilizing a high-fidelity simulator, 12 experienced flight nurses and paramedics performed both methods after a didactic lecture, simulator briefing, and demonstration of each technique. Six participants performed the three-step method first, and the remaining 6 performed the conventional method first. Each participant was filmed and timed. We analyzed videos with respect to the number of hand repositions, number of airway instrumentations, and technical complications. Times to successful completion were measured from incision to balloon inflation.
  
  
  RESULTS
  The three-step method was completed faster (52.1 s vs. 87.3 s; p = 0.007) as compared with conventional surgical cricothyroidotomy. The two methods did not differ statistically regarding number of hand movements (3.75 vs. 5.25; p = 0.12) or instrumentations of the airway (1.08 vs. 1.33; p = 0.07). The three-step method resulted in 100% successful airway placement on the first attempt, compared with 75% of the conventional method (p = 0.11). Technical complications occurred more with the conventional method (33% vs. 0%; p = 0.05).
  
  
  CONCLUSIONS
  The three-step method, using an elastic bougie with an endotracheal tube, was shown to require fewer total hand movements, took less time to complete, resulted in more successful airway placement, and had fewer complications compared with traditional cricothyroidotomy.
authors.affiliation: Division of Acute Care Surgery, Department of Surgery, University of Missouri, Columbia, Missouri.
authors.forename: Jacob A
authors.initials: JA
authors.lastname: Quick
authors.affiliation: Sunrise Hospital and Medical Center, Desert Surgical Associates, Las Vegas, Nevada.
authors.forename: Allan D
authors.initials: AD
authors.lastname: MacIntyre
authors.affiliation: Division of Acute Care Surgery, Department of Surgery, University of Missouri, Columbia, Missouri.
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Barnes
mesh_terms: D003413:Cricoid Cartilage / Q000601:surgery*; D004502:Education, Medical, Continuing / Q000379:methods; D004632:Emergency Medical Services; D004635:Emergency Medicine / Q000193:education; D006801:Humans; D016544:Patient Simulation; D013663:Teaching / Q000379:methods; D014139:Tracheostomy / Q000379:methods*
keywords: cricothyroidotomy; cricothyrotomy; simulation; three-step; training