Conio: Et encore pour la technique chirurgicale

Surgicric 2: A comparative bench study with two established emergency cricothyroidotomy techniques in a porcine model.

Chrisman L Al Br J Anaesth. 2016 Aug;117(2):236-42

 

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Bien que les techniques percutanées faisant appel soient utilisées de préférence par les médecins anetshésistes, il faut se résoudre à une certitude: La coniotomie chirurgicale est plus sûre et efficinete. Ce travail en est une preuve de plus. Tout particulièrement les taux de lésions de la paroi postérieure est le plus faible et il n'y a aucun échec de la technique. Un bistouri, une canule, et un mandrin d'eschmann pour tuteur suffisent.

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BACKGROUND:

'Can't Intubate, Can't Oxygenate' is a rare but life threatening event. Anaesthetists must be trained and have appropriate equipment available for this. The ideal equipment is a topic of ongoing debate. To date cricothyroidotomy training for anaesthetists has concentrated on cannula techniques. However cases reported to the NAP4 audit illustrated that they were associated with a high failure rate. A recent editorial by Kristensen and colleagues suggested all anaesthetists must master a surgical technique. The surgical technique for cricothyroidotomy has been endorsed as the primary technique by the recent Difficult Airway Society 2015 guidelines.

METHODS:

We conducted a bench study comparing the updated Surgicric 2 device with a scalpel-bougie-tube surgical technique, and the Melker seldinger technique, using a porcine model. Twenty six senior anaesthetists (ST5+) participated. The primary outcome was insertion time. Secondary outcomes included success rate, ease of use, device preference and tracheal trauma.

RESULTS:

There was a significant difference (P<0.001) in the overall comparisons of the insertion times. The surgical technique had the fastest median time of 62 s. The surgical and Surgicric techniques were significantly faster to perform than the Melker (both P<0.001). The surgical technique had a success rate of 85% at first attempt, and 100% within two attempts, whereas the others had failed attempts. The surgical technique was ranked first by 50% participants and had the lowest grade of posterior tracheal wall trauma, significantly less than the Surgicric 2 (P=0.002).

CONCLUSIONS:

This study supports training in and the use of surgical cricothyroidotomy by anaesthetists.