Coniotomie: Chirurgie vs percutané ?

Prehospital Emergency Care
Volume 8, Issue 4, October-December 2004, Pages 424-426

 

A laboratory comparison of emergency percutaneous and surgical cricothyrotomy by prehospital personnel

Michelle Fischer Keane MD^, , Kathryn H. Brinsfield MD, K. Sophia Dyer MD, Simon Roy MD and Daniel White EMT-P

from the Boston University School of Medicine (MFK, KHB, KSD, SR), Boston Medical Center (MFK, KHB, KSD, SR), and Boston Emergency Medical Services (MFK, KHB, KSD, DW), Boston, Massachusetts.

Received 15 January 2004;  

revised 18 May 2004;  

accepted 21 May 2004.  

Available online 1 October 2004. 

 

Abstract

Objective

To compare the speeds and success rates of placement for percutaneous cricothyrotomy versus surgical or open cricothyrotomy.

Methods

Twenty-two paramedics (mean 9.7 years of experience), with training in both methods, were timed using a pig trachea in a crossover model. An emergency physician performed timing and documentation of success; timing commenced after the equipment was ready and the membrane was identified. Paramedics were randomly assigned by a coin toss to start in either group. All were actively employed by a municipal third-service emergency medical services (EMS) agency. Paramedics who did not complete one of the methods correctly were excluded from speed analysis. Data were analyzed using descriptive statistics, a t-test of paired samples, and confidence intervals for matched samples.

Results

Placement of a surgical cricothyrotomy was significantly faster (mean 28 seconds, range 10–78 seconds) than the percutaneous method (mean 123 seconds, range 58–257 seconds) (p < 0.001). Mean difference between the 20 matched percutaneous versus surgical pairs was 93.75 seconds (95% CI 72.3, 115.2). The surgical route had a 100% success rate at obtaining airway control, whereas the percutaneous method had a 90.9% success rate (p = 0.1).

Conclusion

In an animal model, surgical cricothyrotomy appeared to be a preferable method for establishing a definitive airway over the percutaneous method. Further research is required to define the optimal approach in the prehospital setting for the invasive airway.