Cricothyroid Membrane Identification in a Female Model: Modified Laryngeal Handshake Versus Traditional Palpation

Area of Science:

• Emergency Medicine
• Surgical Anatomy
• Military Medicine

Background:

• Cricothyrotomy is a life-saving battlefield airway intervention.
• Accurate cricothyroid membrane (CTM) identification is crucial but challenging in female patients due to anatomical variations.
• This study compares two CTM identification techniques in a female model.

Purpose of the Study:

• To evaluate the accuracy of the Modified Laryngeal Handshake (MLH) versus the Traditional Palpation Method (TM) for cricothyroid membrane (CTM) identification in a female model.
• To assess secondary outcomes including time, deviation, and confidence.
• To inform potential improvements in battlefield airway management training.

Main Methods:

• A prospective, randomized controlled trial involving 29 U.S. Army medics (68W).
• Medics were randomized to use either the MLH or TM technique on a standardized live female model.
• Success was defined as identification within CTM borders and 5 mm of midline; secondary outcomes included time, deviation, and confidence.

Main Results:

• No statistically significant difference in CTM identification success rates between the MLH (36%) and TM (33%) groups (P > .99).
• Secondary outcomes, including time to task completion (P = .057) and confidence (P = .53), also showed no significant differences.
• Both techniques yielded similarly low accuracy in this female model.

Conclusions:

• U.S. Army medics exhibit comparable low accuracy in CTM identification on female models using both MLH and TM techniques.
• Current methods may be insufficient for precise CTM localization in female patients.
• Enhanced training protocols addressing sex-specific anatomical differences are necessary to improve cricothyrotomy success in prehospital battlefield settings.