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Randomized Controlled Trial
. 2013 Aug;30(8):646-9.
doi: 10.1136/emermed-2012-201493. Epub 2012 Jul 27.

Emergency cricothyroidotomy performed by inexperienced clinicians--surgical technique versus indicator-guided puncture technique

Matthias Helm  1 , Björn Hossfeld, Christian Jost, Lorenz Lampl, Tobias Böckers
Affiliations
Free PMC article
Randomized Controlled Trial

Emergency cricothyroidotomy performed by inexperienced clinicians--surgical technique versus indicator-guided puncture technique

Matthias Helm et al. Emerg Med J. 2013 Aug.
Free PMC article

Abstract

Background: To improve the ease and safety of cricothyroidotomy especially in the hand of the inexperienced, new instruments have been developed. In this study, we compared a new indicator-guided puncture technique (PCK) with standard surgical technique (ST) regarding success rate, performance time and complications.

Methods: Cricothyroidotomy in 30 human cadavers performed by 30 first year anaesthesia residents. The set chosen for use was randomised: PCK-technique (n=15) and ST (n=15). Success rates, insertion times and complications were compared. Traumatic lesions were anatomically confirmed after dissection.

Results: The ST-group had a higher success rate (100% vs 67%; p=0.04). There was no difference in time taken to complete the procedure (PCK 82 s. vs ST 95 s.; p=0.89). There was a higher complication rate in the PCK-group (67% vs 13%; p=0.04). Most frequent complication in the PCK-group was injury to the posterior tracheal wall (n=8), penetration to the oesophageal lumen (n=4) and injury to the thyroid and/or cricoid cartilage (n=5). In the ST-group in only 2 cases minor complications were observed (small vessel injury).

Conclusions: In this human cadaver study the PCK technique produced more major complications and more failures than the ST. In the hand of the inexperienced operator the standard surgical approach seems to be a safe procedure, which can successfully be performed within an adequate time. The PCK technique cannot be recommended for inexperienced operators.

Keywords: Cricothyroidotomy; airway; anaesthesia; difficult airway management; emergency departments; equipment evaluation; management; puncture technique; standard surgical technique; surgical airway; training.

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Conflict of interest statement

Competing interests: None.

Figures

Figure 1
Figure 1
The standard surgical technique set.
Figure 2
Figure 2
The Portex Cricothyroidotomy Kit set.
Figure 3
Figure 3
Severe posterior tracheal wall injury and penetration into oesophageal lumen after tracheal access with the Portex Cricothyroidotomy Kit technique.
See this image and copyright information in PMC

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