title: A new strategy for difficult airway management with visual needle cricothyroidotomy: a manikin study.
abstract: BACKGROUND
  Conventional needle cricothyroidotomy uses blind manipulation. We investigated the feasibility and efficiency of a new visually guided needle cricothyroidotomy technique.
  
  
  METHODS
  A 0.9-mm microimaging fiber was delivered into a 14G needle to develop a visual puncture system. 10 inexperienced physicians were randomly assigned to perform 10 repeated needle cricothyroidotomy in each group with both conventional method and visual puncture in a manikin. Tracheal lumen puncture time and number of procedure-related complications were recorded.
  
  
  RESULTS
  Under visual guidance, the needle successfully reached the tracheal lumen. The anatomy of the upper and lower airways was acquired by further advancing the microimaging fiber into the tracheal lumen of the visual group. The tracheal lumen puncture time was significantly less in the visual group than in the conventional group (3.85 ± 1.54 vs. 9.84 ± 1.08 seconds, P < .001). Damage to the posterior tracheal wall was not observed in the visual group; however, 21% of manikins in the conventional group had procedure-related complications.
  
  
  CONCLUSIONS
  Our results demonstrate that visual needle cricothyroidotomy is feasible, and may lead to a decrease in procedure time and procedure-related complications compared to the conventional procedure. In addition, this strategy may also provide useful information for diagnostic purposes; therefore, visual needle cricothyroidotomy may be a new strategy for the management of difficult airways in future care.
authors.affiliation: Department of Respiratory Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China.
authors.forename: Yanmei
authors.initials: Y
authors.lastname: Feng
authors.affiliation: Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China.
authors.forename: Huisheng
authors.initials: H
authors.lastname: Deng
authors.affiliation: Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China.
authors.forename: Xun
authors.initials: X
authors.lastname: Liu
authors.affiliation: Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China.
authors.forename: Gang
authors.initials: G
authors.lastname: Xu
authors.affiliation: Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China.
authors.forename: Ziyang
authors.initials: Z
authors.lastname: Huang
authors.affiliation: Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China.
authors.forename: Bingbing
authors.initials: B
authors.lastname: Yan
authors.affiliation: Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China.
authors.forename: Yijun
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China.
authors.forename: Jingjing
authors.initials: J
authors.lastname: Lv
authors.affiliation: Department of Ultrasound, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China. Electronic address: guo-rui5@163.com.
authors.forename: Rui
authors.initials: R
authors.lastname: Guo
mesh_terms: D058109:Airway Management / Q000379:methods*; D002983:Clinical Competence; D003413:Cricoid Cartilage / Q000601:surgery*; D005240:Feasibility Studies; D006801:Humans; D008348:Manikins; D009339:Needles; D011677:Punctures; D020535:Video-Assisted Surgery / Q000379:methods*