Training for cricothyroidotomy

Abstract

Cricothyroidotomy is infrequently performed in the intensive care unit but may be a lifesaving procedure. The aim of this study was to determine the number of attempts required by trainees to gain adequate skills for a successful cricothyroidotomy (defined as lung inflation <60 seconds). The effect of training on time to completion of cricothyroidotomy was also studied. After viewing a demonstration video on the procedure, each participant attempted cricothyroidotomy five times consecutively on a manikin with a pre-assembled Melker cricothyroidotomy kit. Time from 'skin' palpation to 'lung' inflation was recorded for 30 participants. Time to completion of cricothyroidotomy decreased over consecutive attempts within each participant (F4df=39.6; P <0.001) and between participant variability in times recorded at each attempt also decreased (P=0.04). Overall improvement in time to completion was seen even between the fourth and fifth attempts (mean difference -6.3 seconds; P <0.001). All participants were successful by the fifth attempt, by which stage all but two had been successful on two consecutive attempts. Age, years of postgraduate practice and level of seniority appeared to be associated with earlier success. Consecutive attempts on a manikin led to an improvement in the time to completion of cricothyroidotomy and rate of a successful outcome (<60 seconds). We recommend that clinicians undergo at least five training attempts on a manikin to gain proficiency in cricothyroidotomy.

Keywords: cricothyroidotomy; difficult airway; intensive care unit; training.