Emergency cricothyroidotomy: a randomised crossover study of four methods.

Area of Science:

• Emergency Medicine
• Surgical Procedures
• Airway Management

Background:

• Emergency cricothyroidotomy is a critical skill for managing difficult airways.
• Assessing the effectiveness of different cricothyroidotomy techniques and devices is essential for improving patient outcomes.

Purpose of the Study:

• To compare the success rates and time to ventilation for emergency cricothyroidotomy using a standard surgical approach and three commercial devices (Minitrach II, Quicktrach, Melker kit).
• To evaluate the performance of these methods in the absence of refresher training.

Main Methods:

• Emergency physicians and registrars performed cricothyroidotomy on an artificial airway model.
• Four methods were tested: standard surgical, Minitrach II, Quicktrach, and Melker kit.
• The order of methods was randomized to minimize learning effects.

Main Results:

• Standard surgical, Minitrach II, and Quicktrach methods achieved ventilation within 150 seconds with universal success.
• The Melker kit had a 26% failure rate and significantly longer median time to ventilation (126s vs. <=48s).
• Quicktrach and Minitrach II were preferred by most operators (78% and 70%).

Conclusions:

• Emergency physicians can successfully perform emergency cricothyroidotomy using standard surgical techniques, Quicktrach, and Minitrach II without recent refresher training.
• The Melker kit demonstrated significant delays or failure to establish an airway under these conditions.
• Quicktrach and Minitrach II are viable and preferred alternatives to the standard surgical approach in emergency settings.