Emergency Cricothyrotomy Performed by Surgical Airway-naive Medical Personnel: A Randomized Crossover Study in Cadavers Comparing Three Commonly Used Techniques.
BACKGROUND
When conventional approaches to obtain effective ventilation and return of effective spontaneous breathing fail, surgical airway is the last rescue option. Most physicians have a limited lifetime experience with cricothyrotomy, and it is unclear what method should be taught for this lifesaving procedure. The aim of this study is to compare the performance of medical personnel, naive to surgical airway techniques, in establishing an emergency surgical airway in cadavers using three commonly used cricothyrotomy techniques.


METHODS
Twenty medical students, without previous knowledge of surgical airway techniques, were randomly selected from their class. After training, they performed cricothyrotomy by three techniques (surgical, Melker, and QuickTrach II) in a random order on 60 cadavers with comparable biometrics. The time to complete the procedure, rate of success, and number of complications were recorded. A success was defined as the correct placement of the cannula within the trachea in 3 min.


RESULTS
The success rates were 95, 55, and 50% for surgical cricothyrotomy, QuickTrach, and Melker, respectively (P = 0.025). The majority of failures were due to cannula misplacement (15 of 20). In successful procedures, the mean procedure time was 94 ± 35 s in the surgical group, 77 ± 34 in the QuickTrach II group, and 149 ± 24 in the Melker group (P < 0.001). Few significant complications were found in successful procedures. No cadaver biometric parameters were correlated with success of the procedure.


CONCLUSIONS
Surgical airway-naive medical personnel establish emergency cricothyrotomy more efficiently and safely with the surgical procedure than with the other two commonly used techniques.
From the Departments of Oto-Rhino-Laryngology-Head and Neck Surgery (F.H., S.G., P.D.), Surgery-Oral and Maxillofacial Surgery (D.S.C.), Psychiatry (K.M.W.), Geneva University Hospital, Geneva, Switzerland; and Institute of Anatomy, Medical University of Graz, Graz, Austria (G.F.).
Frédéric
F
Heymans
Georg
G
Feigl
Stephan
S
Graber
Delphine S
DS
Courvoisier
Kerstin M
KM
Weber
Pavel
P
Dulguerov
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D002404:Catheterization / Q000379:methods; D003413:Cricoid Cartilage / Q000601:surgery*; D018592:Cross-Over Studies; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D009333:Neck / Q000033:anatomy & histology; D013337:Students, Medical; D011795:Surveys and Questionnaires; D013957:Thyroid Cartilage / Q000601:surgery*; D014132:Trachea; D014140:Tracheotomy / Q000193:education* / Q000379:methods*; D055815:Young Adult