Use of the Trousseau dilator in cricothyrotomy

When performing cricothyrotomy, once the initial incision has been created, the scalpel handle may be inserted into the incision and rotated, or a Trousseau dilator may be used to widen the opening. During endotracheal (ET) tube passage, the Trousseau dilator may be left in place or a tracheal hook may be inserted for tracheal stabilization. This experimental crossover trial of cricothyrotomy in a cadaver model compared: 1) scalpel handle rotation to the use of a Trousseau dilator in widening the initial incision, and 2) the use of a tracheal hook to a Trousseau dilator during ET tube passage. Part 1: Cricothyrotomy incisions were made in 30 formalin-fixed cadavers using a #11 scalpel blade. The opening was initially widened using a Trousseau dilator or a scalpel handle rotated through 360 degrees. Progressively larger ET tubes were passed using a tracheal hook for stabilization at the thyroid cartilage, and the size of the largest ET tube passed without significant resistance was recorded. Each opening was then widened using the other technique and ET tubes again passed as above. The dimensions of the opening after initial dilatation and after final ET tube passage were also recorded. Part 2: A tracheal hook inserted cephalad at the thyroid cartilage or a Trousseau dilator was used to stabilize the trachea during passage of progressively larger ET tubes, and the size of the largest ET tube passed without significant resistance was recorded. The insertion techniques were then reversed and ET tubes again passed as above. The trachea was inspected for damage and the balloon cuff checked for rupture after each attempt. Descriptive statistics were applied using a paired t-test and a chi-square analysis. We found no significant difference between the two techniques with regard to initial opening dimensions, final opening dimensions, or maximal ET tube size. There was no damage to local tissue and no balloon cuff ruptures. We found that the average size of the largest ET tube passed was significantly greater with the use of a tracheal hook (internal diameter mean 7.0 mm, median 7.0 mm) than with a Trousseau dilator (internal diameter mean 5.7 mm, median 5.5 mm). There was no damage to local tissue and no cuff ruptures. We conclude that the scalpel handle rotation technique is equal to the use of the Trousseau dilator with regard to opening size and maximal ET tube size but that use of a tracheal hook rather than a Trousseau dilator allows for passage of a larger ET tube in a cadaver model of cricothyrotomy.