Emergency cricothyroidotomy: a randomized crossover trial comparing percutaneous techniques: classic needle first...

Area of Science:

• Emergency Medicine
• Surgical Techniques
• Airway Management

Background:

• Emergency cricothyroidotomy is a critical, potentially lifesaving procedure for patients with severe airway compromise.
• Current literature presents divided opinions on the optimal percutaneous insertion technique, specifically comparing open/surgical versus needle-first (NF) methods.

Purpose of the Study:

• To evaluate a modified "incision-first" (IF) percutaneous technique for emergency cricothyroidotomy.
• To compare the efficacy and safety of the IF technique against the traditional NF approach in a simulated setting.

Main Methods:

• A randomized controlled crossover study involving 180 simulated tracheal models.
• Emergency physicians (attending and resident) performed both IF and NF techniques.
• Primary outcome: time to successful cannulation; secondary outcomes: needle/incision/dilation attempts, first-attempt success rate, and subjective ease of use.

Main Results:

• The IF technique was significantly faster (median 53s vs. 90s, p < 0.001).
• Fewer needle insertions were required with the IF technique (p = 0.018).
• Clinicians reported the IF approach as subjectively easier to perform.

Conclusions:

• The IF modification of percutaneous cricothyroidotomy offers faster airway access and fewer complications compared to the standard NF technique.
• The IF technique demonstrates significant advantages and favorable clinician endorsement, suggesting its consideration as an improved emergency airway management method.