Related Experiment Video
Updated: Oct 26, 2025

Endotracheal Intubation via Tracheotomy and Subsequent Thoracotomy in Rats for Non-Survival Applications
Published on: March 15, 2024
Comparing methods to secure a tracheal tube placed via a surgical cricothyroidotomy: a randomised controlled study in
Christopher J Groombridge1,2,3, Amit Maini4,5, Joseph Mathew4,5,6
1National Trauma Research Institute, Melbourne, Australia. christopher.groombridge@monash.edu.
Objective:
In the 'can't intubate can't oxygenate' scenario, techniques to achieve front of neck access to the airway have been described in the literature but there is a lack of guidance on the optimal method for securing the tracheal tube (TT) placed during this procedure. The aim of this study was to compare three different methods of securing a TT to prevent extubation following a surgical cricothyroidotomy.
Methods:
A randomised controlled trial was undertaken. The population studied were emergency physicians (EPs) attending a cadaveric airway course. The intervention was securing a TT placed via a surgical cricothyroidotomy by suture. The comparison was securing the TT using fabric tape with two different tying techniques. The primary outcome was the force required to extubate the trachea. The trial was registered with ANZCTR.org.au (ACTRN12621000320853).
Results:
17 emergency physicians completed intubations using all three of the securing methods on 12 cadavers for a total of 51 experiments. The mean extubation force was 6.54 KG (95 % CI 5.54-7.55) in the suture group compared with 2.28 KG (95 % CI 1.91-2.64) in the 'Wilko tie' group and 2.12 KG (95 % CI 1.63-2.60) in the 'Lark's foot tie' group; The mean difference between the suture and fabric tie techniques was significant (p < 0.001).
Conclusions:
Following a surgical cricothyroidotomy in cadavers, EPs were able to effectively secure a TT using a suture technique, and this method was superior to tying the TT using fabric tape.
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