title: Combining transtracheal catheter oxygenation and needle-based Seldinger cricothyrotomy into a single, sequential procedure.
abstract: BACKGROUND
  Needle-based cricothyrotomy is a common procedure for emergency department patients requiring an emergent surgical airway. Percutaneous transtracheal jet ventilation is well studied to provide oxygenation. We propose to combine these procedures into a novel, single, and sequential procedure.
  
  
  METHODS
  This study was a prospective manikin/human cadaver procedural feasibility study performed at a medical education center. Forty-eight emergency medicine attending physicians and fellows performed the procedure on a single TraumaMan (Simulab Corporation, Seattle, WA), and 26 were randomly selected to perform the procedure on fresh, unfixed human cadavers. The procedure is as follows: 15 gauge/6F catheter-over-needle punctures cricothyroid membrane, needle is removed, and Enk oxygen flow modulator is attached to the catheter (start to oxygenation). The Enk set is detached, a guide wire introduced, and Seldinger cricothyrotomy is performed (oxygenation to cricothyrotomy). Start-to-oxygenation, oxygenation-to-cricothyrotomy, and start-to-cricothyrotomy times were recorded. Manikin procedures were verified by direct visualization, and cadaver procedures were verified by video laryngoscopy.
  
  
  RESULTS
  All attempts were included in data analysis, and there was a 100% first-pass success rate. For the manikin trials, median start-to-oxygenation, oxygenation-to-cricothyrotomy, and start-to-cricothyrotomy times with interquartile ranges were 11 (8.5-13), 48 (42-57), and 59 (53-69) seconds, respectively. For the cadaver trials, median start-to-oxygenation, oxygenation-to-cricothyrotomy, and start-to-cricothyrotomy times with interquartile ranges were 12 (10-15), 59 (47-76), and 71 (61-94) seconds, respectively. Student t tests showed significant differences in start-to-oxygenation and oxygenation-to-cricothyrotomy times (P < .01) within the manikin and cadaver groups.
  
  
  CONCLUSIONS
  Percutaneous transtracheal jet ventilation and needle-based Seldinger cricothyrotomy can be performed by emergency medicine physicians, and a single, sequential procedure may significantly reduce time to oxygenation for patients already undergoing surgical cricothyrotomy.
authors: Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, USA. Electronic address: ericboccio@gmail.com.
authors: Eric
authors: E
authors: Boccio
authors: Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, USA. Electronic address: rgujral@nshs.edu.
authors: Rashmeet
authors: R
authors: Gujral
authors: Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, USA. Electronic address: mcassara@nshs.edu.
authors: Michael
authors: M
authors: Cassara
authors: Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, USA. Electronic address: tamato@nshs.edu.
authors: Teresa
authors: T
authors: Amato
authors: Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, USA. Electronic address: bwie@nshs.edu.
authors: Benjamin
authors: B
authors: Wie
authors: Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, USA. Electronic address: mward@nshs.edu.
authors: Mary Frances
authors: MF
authors: Ward
authors: Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, USA. Electronic address: jdamore@nshs.edu.
authors: Jason
authors: J
authors: D'Amore
mesh_terms: D002102:Cadaver; D003413:Cricoid Cartilage / Q000601:surgery*; D004635:Emergency Medicine / Q000295:instrumentation*; D005240:Feasibility Studies; D006801:Humans; D008348:Manikins; D009339:Needles; D010100:Oxygen / Q000008:administration & dosage*; D011677:Punctures; D014140:Tracheotomy / Q000295:instrumentation*
chemical_list: D010100:Oxygen