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. 2013 May 31:21:43.
doi: 10.1186/1757-7241-21-43.

Emergency cricothyrotomy--a systematic review

Sofie Langvad  1 , Per Kristian Hyldmo, Anders Rostrup Nakstad, Gunn Elisabeth Vist, Marten Sandberg
Affiliations

Emergency cricothyrotomy--a systematic review

Sofie Langvad et al. Scand J Trauma Resusc Emerg Med. .

Abstract

Background: An emergency cricothyrotomy is the last-resort in most airway management protocols and is performed when it is not possible to intubate or ventilate a patient. This situation can rapidly prove fatal, making it important to identify the best method to establish a secure airway. We conducted a systematic review to identify whether there exists superiority between available commercial kits versus traditional surgical and needle techniques.

Methods: Medline, EMBASE and other databases were searched for pertinent studies. The inclusion criteria included manikin, animal and human studies and there were no restrictions regarding the professional background of the person performing the procedure.

Results: In total, 1,405 unique references were identified; 108 full text articles were retrieved; and 24 studies were included in the review. Studies comparing kits with one another or with various surgical and needle techniques were identified. The outcome measures included in this systematic review were success rate and time consumption. The investigators performing the studies had chosen unique combinations of starting and stopping points for time measurements, making comparisons between studies difficult and leading to many conflicting results. No single method was shown to be better than the others, but the size of the studies makes it impossible to draw firm conclusions.

Conclusions: The large majority of the studies were too small to demonstrate statistically significant differences, and the limited available evidence was of low or very low quality. That none of the techniques in these studies demonstrated better results than the others does not necessarily indicate that each is equally good, and these conclusions will likely change as new evidence becomes available.

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Figures

Figure 1
Figure 1
Flow chart showing the number of articles identified and excluded.
Figure 2
Figure 2
Risk of bias analysis for all studies included in the systematic review. Green symbols indicate low risk of bias (blinding or lack of blinding not likely to influence the results), red symbols high risk of bias, while yellow symbols indicate unclear risk of bias.
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Comment in

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