Percutaneous vs surgical emergency cricothyroidotomy: An experimental randomized crossover study on an animal‐larynx model

Abstract

Background Airway management is a paramount clinical skill for the anaesthesiologist. The Emergency Cricothyroidotomy (EC) constitutes the final step in difficult airway algorithms securing a patent airway via a front‐of‐neck access. The main distinction among available techniques is whether the procedure is surgical and scalpel‐based or percutaneous and needle‐based. Methods In an experimental randomized crossover trial, using an animal larynx model, we compared two EC techniques; the Rapid Four Step Technique and the Melker Emergency Cricothyrotomy Kit®. We assessed time expenditure and success rates among 20 anaesthesiologists and related this to previous training, seniority and clinical experience with EC. Results All participants achieved successful airway access with both methods. Average time to successful airway access for scalpel‐based EC was 54 (±31) seconds and for percutaneous EC 89 (±38) seconds, with 35 (95% CI: 14‐57) seconds time difference, P = .003. Doctors with recent (<12 months) EC training performed better compared to the non‐training group (37 vs 61 seconds, P = .03 for scalpel‐based EC, and 65 vs 99 seconds, P = .02 for percutaneous EC). We found no differences according to clinical seniority or previous real‐life EC experience. Conclusions Our study demonstrated that anaesthesiologists achieved successful airway access on an animal experimental model with both EC methods within a reasonable time frame, but the scalpel‐based EC is performed more promptly. Recent EC training affected the time expenditure positively, while seniority and clinical EC experience did not. EC procedures should be regularly trained for.

Emergency cricothyroidotomy in difficult airway simulation – a national observational study of Air Ambulance crew performance

“…Experimental studies have found time expenditure for RFST-procedure in a range about 60 s [ 16 – 18 ]. These studies have in common that they have been performed on various laryngeal models, in which the operator does not have to consider other clinical factors.…”

Emergency Cricothyroidotomy in Difficult Airway Simulation – A National Observational Study of Air Ambulance Crew Performance

“…Experimental studies have found time expenditure for RFST-procedure in a range about 60 seconds [15][16][17]. These studies have in common that they have been performed on various laryngeal models, in which the operator does not have to consider other clinical factors.…”

Comparison of emergency surgical cricothyroidotomy and percutaneous cricothyroidotomy by experienced airway providers in an obese, in vivo porcine hemorrhage airway model

“…The stress was induced by an unpreparedness for the CICO combined with continuous clinical feedback of desaturation and hypotension during the procedure. Therefore, we did not perform a cross-over design, in comparison to studies without stress induction [ 2 , 24 , 28 , 30 , 38 , 39 ]. We intended to test a comparable group of clinically active anesthesiologists, as anesthesiologists may often be the primary responders to unexpected CICO situations.…”

“…Therefore, pigs of this size may be described as obese neck models [ 2 , 4 , 43 , 44 ]. Obese neck models are relevant in advanced airway management, as the risk of CICO increases in patients with difficult neck anatomy [ 2 , 30 , 31 , 39 ]. The increased number of adverse events in percutaneous cricothyroidotomy was likely related to the difficulty of accessing the trachea.…”