title: Comparing success rates of anesthesia providers versus trauma surgeons in their use of palpation to identify the cricothyroid membrane in female subjects: a prospective observational study.
abstract: OBJECTIVE
  The primary aim of this study was to compare the success rates of anesthesia providers vs trauma surgeons in their use of palpation to identify the cricothyroid membrane (CTM). The secondary aim was to explore whether prior training and experience performing surgical airways affected the success rates for identifying the CTM.
  
  
  METHODS
  Four female adults participated in this prospective observational study. The participants had varying measurements of neck anatomy that were known or theorized to affect the accuracy of identifying the CTM location. For test purposes, the subjects were positioned with optimal neck extension via placement of a shoulder roll. Anesthesia providers (n = 57) and surgeons (n = 14) of various training levels and clinical experience marked the presumed CTM location on each subject. These palpation markings were then referenced against the ultrasound-confirmed CTM location, and the success rates for identifying the CTM were compared between groups.
  
  
  RESULTS
  The overall success rate using palpation to identify the CTM was ≤ 50%, and there were no differences in success rates between the anesthesia providers and trauma surgeons (16% vs 26%, respectively; absolute difference, -10%; 95% confidence interval, -23 to 3; P = 0.15). Furthermore, there were no significant differences in the success rates for identifying the CTM based on either clinical experience or emergency surgical airway experience.
  
  
  CONCLUSIONS
  The success rates for identifying the CTM using palpation were low and not significantly different for anesthesia providers and surgeons, collectively, as well as for the various levels of training. Anesthesiologists' ability to mark the CTM location correctly did not improve with years of experience.
authors.affiliation: Memorial Hermann Memorial City Medical Center, Houston, TX, USA. hillerk2@yahoo.com.
authors.forename: Kenneth N
authors.initials: KN
authors.lastname: Hiller
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA.
authors.forename: Ron J
authors.initials: RJ
authors.lastname: Karni
authors.affiliation: Department of Internal Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA.
authors.forename: Chunyun
authors.initials: C
authors.lastname: Cai
authors.affiliation: Department of Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA.
authors.forename: John B
authors.initials: JB
authors.lastname: Holcomb
authors.affiliation: Department of Anesthesiology, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA.
authors.forename: Carin A
authors.initials: CA
authors.lastname: Hagberg
mesh_terms: D000328:Adult; D000072080:Anesthesiologists / Q000706:statistics & numerical data*; D002983:Clinical Competence / Q000706:statistics & numerical data*; D003413:Cricoid Cartilage / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008875:Middle Aged; D010173:Palpation / Q000379:methods / Q000706:statistics & numerical data*; D011446:Prospective Studies; D015203:Reproducibility of Results; D066231:Surgeons / Q000706:statistics & numerical data*; D013957:Thyroid Cartilage / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D014463:Ultrasonography