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Needle Cricothyroidotomy by Intensive Care Paramedics
Rembrandt Bye1, Toby St Clair1,2,3, Ashleigh Delorenzo1,2
1Department of Paramedicine, Monash University, Victoria, Australia.
Needle cricothyroidotomy success improved with a pre-puncture surgical incision. Intensive care paramedics (ICPs) using the QuickTrach II (QTII) device saw better front-of-neck access (FONA) rates after workflow changes.
Area of Science:
- Emergency Medicine
- Airway Management
- Paramedic Practice
Background:
- Cricothyroidotomy is a critical advanced airway procedure for unstable patients.
- Intensive care paramedics (ICPs) in Victoria, Australia, use the QuickTrach II (QTII) device for needle cricothyroidotomy.
- A recent workflow change introduced a pre-puncture surgical incision before QTII insertion.
Purpose of the Study:
- To evaluate the impact of a pre-puncture surgical incision on needle cricothyroidotomy success rates.
- To assess the effectiveness of the QuickTrach II (QTII) device in front-of-neck access (FONA) procedures.
- To analyze procedural success rates before and after a workflow modification.
Main Methods:
- Retrospective review of all needle cricothyroidotomy cases performed by ICPs.
- Data collected from Ambulance Victoria (AV) data warehouse from May 1, 2015, to September 15, 2020.
- Analysis of patient records to determine procedural success rates.
Main Results:
- A total of 27 patients underwent needle cricothyroidotomy, with 92.6% using the QTII device.
- Front-of-neck access (FONA) success rate increased from 50.0% to 82.4% after the procedural update.
- The overall success rate for paramedic-performed needle cricothyroidotomy during the study period was 74.1%.
Conclusions:
- Proprietary devices like the QTII show a low success rate for FONA interventions.
- ICPs can achieve reasonable success with needle cricothyroidotomy using scalpel assistance and regular training.
- Surgical cricothyroidotomy techniques may offer higher success rates compared to needle techniques in broader literature.
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