Emergency cricothyroidotomy: a randomised crossover study of four methods

Abstract

Emergency physicians and registrars performed emergency cricothyroidotomy on an artificial airway model using a standard surgical approach and three common commercial products, participants had received no refresher training. The order in which the methods were used was randomised to minimise any learning effect. Three methods (standard surgical, Minitrach II, and Quicktrach) were universally successful in obtaining ventilation within 150 s, whilst the Melker kit had a 26% failure rate and significantly longer median time to ventilation (126 s vs<or=48 s for other methods, p < 0.001). Despite success in using the surgical method, the Quicktrach and Minitrach II were rated as first or second preference by the majority of operators (78% and 70% respectively). Without refresher training emergency physicians and registrars successfully performed emergency cricothyroidotomy using the standard surgical method, Quicktrach and Minitrach II kits however the use of the Melker kit under these conditions resulted in significant delays or failure to establish an airway.