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A comparison of a new indicator-guided with a conventional wire-guided percutaneous cricothyroidotomy device in
Nicole M Assmann1, David T Wong, Eduardo Morales
1Department of Anesthesia, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada.
Background:
Percutaneous cricothyroidotomy may be a life-saving procedure in cannot intubate-cannot ventilate situations. In this study we compared the insertion times of a new indicator-guided cricothyroidotomy device and a wire-guided device in mannequins.
Methods:
This study was a crossover trial comparing the insertion times and success rates of an indicator-guided tube-over-needle device and a wire-guided cricothyroidotomy device in a mannequin. After an audiovisual training session, 64 anesthesiologists performed five cricothyroidotomies with each of the two devices. Successful insertion was defined as insertion of a device into the correct anatomic location. The insertion times and success rates between the two techniques for the five attempts were compared using repeated measures ANOVA, paired t-test, and chi(2) analyses.
Results:
Insertion times were faster (32.6 +/- 14.9 s vs 42.3 +/- 12.5 s, P < 0.001) while success rates were similar (95% vs 93.1%) with the indicator-guided device when compared with the wire-guided device. For both devices, performance improved with repeated attempts. Four insertion attempts (1.3%) were positioned anterior or posterior to the trachea lumen with the indicator-guided device compared to none with the wire-guided device (P = 0.12) Subjectively, more participants chose to use the wire-guided than the indicator-guided device (59% vs 31%, P < 0.001) in a clinical emergency situation.
Conclusion:
In a mannequin model, cricothyroidotomy insertion times were faster for the indicator-guided technique than for the wire-guided technique, but success rates were similar. Subjectively, more participants chose to use the wire-guided device in a clinical emergency situation.
