title: [A novel tracheostomy technique for emergency airway: a randomized controlled study in minipigs].
abstract: OBJECTIVE
  To compare cricothyroid membrane puncture directed tracheostomy (CMPDT) with conventional surgical tracheostomy (ST) and cricothyroidotomy (CT) and to evaluate the feasibility, efficacy and safety of this novel technique.
  
  
  METHODS
  15 minipigs were divided randomly into 3 groups, 5 in each. After general anesthesia, CMPDT, ST and CT were performed respectively according to the established techniques when SPO₂reached 80% (T0). Procedure duration, ECG and arterial blood gas results were recorded. Complications were recorded and scored according to an established score scale by an observer blinded to the grouping.
  
  
  RESULTS
  Airway was successfully established in all animals (15/15). ECG monitor showed T-wave decreased and Q-T shortened after seasing of oxygen supply and both recovered rapidly to normal levels after reoxygenation. There were no significant differences between 3 groups in HR, BP, SPO2, SaO₂, PaO₂, PaCO₂and pH at pre-apnea, T0 or post-operation, but with significant intragroup variation in the parameters before and after operation. The time for CMPDT, ST and CT was (174 ± 34) s, (619 ± 128) s and (86 ± 12) s respectively. Three of 5 minipigs in ST group experienced hypotension due to longer time of hypoxia. 1 and one had minor bleeding and stoma infection after surgery. One of 5 animals in CT group had minor laryngeal cartilage injury leading to difficult decannulation, postoperative fiber bronchoscopy showed no subglottic stenosis. The complication scores were 13, 9, and 3 for ST, CT and CMPDT, respectively.
  
  
  CONCLUSIONS
  All 3 methods can provide with effective airway access with no significant differences in ventilation effect, however CMPDT has short recovery time for SpO2 and other vital signs with the lowest complication score. The animal experiment suggests that CMPDT is a fast, safe and effective surgical technique for emergency airway.
authors.affiliation: Chinese PLA Medical School, Beijing 100853, China.
authors.forename: Youbai
authors.initials: Y
authors.lastname: Chen
authors.forename: Qixu
authors.initials: Q
authors.lastname: Zhang
authors.affiliation: Department of Oral and Maxillofacial Surgery, Chinese PLA General Hospital, Beijing 100853, China; Email: zhanghz301@yahoo.com.cn.
authors.forename: Haizhong
authors.initials: H
authors.lastname: Zhang
mesh_terms: D000768:Anesthesia, General; D000818:Animals; D001784:Blood Gas Analysis; D001999:Bronchoscopy; D004638:Emergency Treatment / Q000379:methods; D000860:Hypoxia; D007830:Larynx / Q000601:surgery*; D013552:Swine; D013556:Swine, Miniature; D014139:Tracheostomy / Q000379:methods*