Cricothyroid Membrane Puncture-Guided Tracheostomy: A New Technique for Emergency Airway Access

We sought to compare cricothyroid membrane puncture-guided tracheostomy (CMPGT) with surgical cricothyroidotomy (SC) and percutaneous tracheostomy with Griggs' guidewire dilating forceps (GWDF) for establishing an emergency airway in a porcine model. We hypothesized that CMPGT would be associated with a shorter time to ventilation and more rapid restoration of oxygenation.

We implemented a small pilot animal study. Eighteen miniature pigs were randomly assigned to undergo CMPGT, SC, or GWDF. The predictor variable was the technique used. The primary outcome variable was time to ventilation. Other outcome variables were efficiency of oxygenation restoration, procedure duration, and procedure-related complications. The data were assessed using 1-way analysis of variance and Bonferroni correction. The oxygen saturation (SpO₂) changes over time were graphed using a time-series line plot. Statistical significance was set at P < .05.

Airways were successfully established in all 18 pigs. SC (68 ± 4 seconds) showed the shortest procedure duration compared with GWDF (95 ± 3 seconds) and CMPGT (96 ± 4 seconds); however, the time to ventilation using CMPGT (21 ± 2 seconds) was significantly shorter than that with SC (68 ± 4 seconds) and GWDF (95 ± 3 seconds) (P < .01). Spo₂ in each group increased postoperatively, reaching 95% at 120 seconds, 131 seconds, and 144 seconds in the CMPGT, SC, and GWDF groups, respectively. The slope of the ascending phase of the Spo₂ curve was 0.38 for CMPGT, 0.42 for SC, and 0.53 for GWDF (P < .05). Two pigs in each group had minor intraoperative bleeding, and 1 pig in the SC group had moderate bleeding.

The results of this animal study suggest that CMPGT is a time-efficient and safe technique for emergency airway access that allows for a more rapid return of ventilation and obviates conversion to definitive tracheostomy. Further cadaveric study is ongoing.