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Emergency Cricothyrotomy Performed by Surgical Airway–naive Medical Personnel

Heymans F. et Al. Anesthesiology 2016; 125:295-303

 

BACKGROUND:

When conventional approaches to obtain effective ventilation and return of effective spontaneous breathing fail, surgical airway is the last rescue option. Most physicians have a limited lifetime experience with cricothyrotomy, and it is unclear what method should be taught for this lifesaving procedure. The aim of this study is to compare the performance of medical personnel, naive to surgical airway techniques, in establishing an emergency surgical airway in cadavers using three commonly used cricothyrotomy techniques.

METHODS:

Twenty medical students, without previous knowledge of surgical airway techniques, were randomly selected from their class. After training, they performed cricothyrotomy by three techniques (surgical, Melker, and QuickTrach II) in a random order on 60 cadavers with comparable biometrics. The time to complete the procedure, rate of success, and number of complications were recorded. A success was defined as the correct placement of the cannula within the trachea in 3 min.

RESULTS:

The success rates were 95, 55, and 50% for surgical cricothyrotomy, QuickTrach, and Melker, respectively (P = 0.025). The majority of failures were due to cannula misplacement (15 of 20). In successful procedures, the mean procedure time was 94 ± 35 s in the surgical group, 77 ± 34 in the QuickTrach II group, and 149 ± 24 in the Melker group (P < 0.001). Few significant complications were found in successful procedures. No cadaver biometric parameters were correlated with success of the procedure.

	Surgical Technique	QuickTrach II	Melker
Success rate (%)) )	19 (95	11 (55)	10 (50	0.025
Failure due to time limitation (%)	0	1 (5)	4 (20)	0.203
Incorrect placement (%)	1 (5)	8 (40) )	6 (30)	0.106
Cricothyrotomy time over 3 min	0	3	6	0.257
Time to complete the procedure—mean (s)	94±35		149±24	< 0.001
Total complications in successful procedures	1	4	1	0.018
SPC: posterior tracheal wall lesion	1	3	1
SPC: esophageal perforation 1			10 (50
Total complications in failed procedures	1	8	6	0.205
FPC: esophageal intubation	1	2	1
FPC: pretracheal false passage		4	3
FPC: cannula in pharynx 1 2		1	2
FPC: broken device 1		1
FPC = failed procedure complications; SPC = successful procedure complications.

"....In conclusion, our results indicate that medical personnel naive to surgical airway techniques establish a surgical airway more efficiently using surgical cricothyroidotomy. Since the vast majority of clinicians perform emergency airway infrequently, our observation might apply to the majority of them. Whether surgical cricothyrotomy remains superior in advance-trained medical personnel requires further study......" 

CONCLUSION:

Surgical airway-naive medical personnel establish emergency cricothyrotomy more efficiently and safely with the surgical procedure than with the other two commonly used techniques.