Evaluation of a novel Surgicric^® cricothyroidotomy device for emergency tracheal access in a porcine model

Abstract

SummaryA can't intubate, can't ventilate scenario can result in morbidity and death. Although a rare occurrence (1:50 000 general anaesthetics), it is crucial that anaesthetists maintain the skills necessary to perform cricothyroidotomy, and are well‐equipped with appropriate tools. We undertook a bench study comparing a new device, Surgicric®, with two established techniques; the Melker Emergency Cricothyroidotomy, and a surgical technique. Twenty‐five anaesthetists performed simulated emergency cricothyroidotomy on a porcine model, with the primary outcome measure being insertion time. Secondary outcomes included success rate, tracheal trauma and ease of use. The surgical technique was fastest. The median (IQR [range]) was 81 (62–126 [37–300]) s, followed by the Melker 124 (100–217 [71–300]) s, and the Surgicric 127 (68–171 [43–300]), p = 0.003. The Surgicric device was the most traumatic, as evaluated by a blinded Ear, Nose and Throat surgeon. Subsequently, the authors contacted the device manufacturer, who has now modified the kit in the hope that its clinical application might be improved. Further studies are required to evaluate the revised model.

Effect of palpable vs. impalpable cricothyroid membranes in a simulated emergency front‐of‐neck access scenario

“…Although we showed a difference in speed of securing an airway with a palpable vs. an impalpable membrane, the timings for the latter were still acceptable, demonstrating the positive effect of training. Both sets of times are comparable to those found by other groups investigating broadly similar bougie-assisted cricothyroidotomy techniques [10][11][12][13], with average procedural times of 33-81 s. Our study, however, is probably the first evaluation of the FONA techniques described in the DAS 2015 guidelines in a benchtop study and showed a high first-attempt success rate.…”

Time to oxygenation for cannula‐ and scalpel‐based techniques for emergency front‐of‐neck access: a wet lab simulation using an ovine model

“…The median time of 90 s (when successful) for participants to achieve scalpel‐bougie eFONA is similar to the time to achieve cricothyroidotomy in several benchtop model studies and a wet lab study .…”

Evaluation of a novel cricothyroidotomy introducer in a simulated obese porcine model: a randomised crossover comparison with scalpel cricothyroidotomy

“…Although there was an added step of inserting the introducer following scalpel incision, the insertion times were significantly faster in this simulated obese model. However, the times taken in this study was longer and required more insertion attempts compared with the cricothyroidotomy studies previously conducted in our institution on a similar porcine model, but with only a thin overlying layer of skin. This correlates with the knowledge that cricothyroidotomy is technically more challenging and demanding in obese subjects, as observed in a previous simulated obese neck study .…”

“…We calculated that we would need a sample size of at least 25 participants to show whether the insertion times for a pair of devices differed by more than a threshold value of 45 s and standard deviation of difference of around 80, using a two‐sided, 5% significance level and 80%, based on two studies comparing cricothyroidotomy techniques conducted in our institution . We used the Wilcoxon matched pairs signed‐rank test to analyse the results (non‐normal distributions) and the McNemar test to compare the success rate, occurrence of false passage and identification of cricothyroid membrane.…”