Coniotomie: D'abord chirurgicale

Evaluation of novel Surgicric
cricothyroidotomy device

King W et Al. Anaesthesia. 2015 Nov 17. doi: 10.1111/anae.13275

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Ce travail est intéressant car il met en avant l'intérêt des techniques chirurgicales par rapport à une technique de référence qui est l'emploi du set de Melker et d'un nouveau kit: le Surgicric. Il montre également que la survenue de lésions de la paroi postérieure n'est pas une vue de l'esprit, cette complication étant la plus fréquente avec ce nouveau kit.

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A 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.