Control Cric: Pas mieux que la conio chirurgicale

A randomized cross-over study comparing surgical cricothyrotomy techniques by combat medics using a synthetic cadaver model

Schauer SG et Al. Am J Emerg Med. 2017 Nov 27. pii: S0735-6757(17)30972-5

 

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Un travail qui compare trois techniques de coniotomie (chirurgicale/QuickTrach II/Control Cric). Les auteurs ne mettent pas en évidence de différence flagrante bien qu'ils émettent une préférence très claire pour le QuickTrach II. La coniotomie chirurgicale est celle avec laquelle le moins d'échec est rencontré. On est surpris des résultats très en retrait obtenus avec le Control-Cric qui est le dispositif retenu en première ligne par l'armée américaine. Dans leur discussion, plus que le matériel c'est l'entraînement qui leur paraît déterminant.

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Cricothyrotomy is a complex procedure with a high rate of complications including failure to cannulate and injury to adjacent anatomy. The Control-Cric™ System and QuickTrach II™ represent two novel devices designed to optimize success and minimize complications with this procedure. This study compares these two devices against a standard open surgical technique.

METHODS:

We conducted a randomized crossover study of United States Army combat medics using a synthetic cadaver model. Participants performed a surgical cricothyrotomy using the standard open surgical technique, Control-Cric™ System, and QuickTrach II™ device in a random order. The primary outcome was time to successful cannulation. The secondary outcome was first-attempt success. We also surveyed participants after performing the procedures as to their preferences.

RESULTS:

Of 70 enrolled subjects, 65 completed all study procedures. Of those that successfully cannulated, the mean times to cannulation were comparable for all three methods: standard 51.0s (95% CI 45.2-56.8), QuickTrach II™ 39.8s (95% CI 31.4-48.2) and the Cric-Control™ 53.6 (95% CI 45.7-61.4). Cannulation failure rates were not significantly different: standard 6.2%, QuickTrach II™ 13.9%, Cric-Control™ 18.5% (p=0.106). First pass success rates were also similar (93.4%, 91.1%, 88.7%, respectively, p=0.670). Of respondents completing the post-study survey, a majority (52.3%) preferred the QuickTrach II™ device.

CONCLUSIONS:

We identified no significant differences between the three cricothyrotomy techniques with regards to time to successful cannulation or first-pass success.