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

Cricothyrotomy is a critical intervention for airway obstruction on the battlefield. Accurate identification of the cricothyroid membrane (CTM) is essential, yet prior literature indicates that CTM localization in female patients is more challenging due to anatomical differences. This study evaluated the accuracy of CTM identification in a female model by U.S. Army medics using the Modified Laryngeal Handshake (MLH) vs the Traditional Palpation Method (TM).

In this prospective, randomized controlled trial, 29 active-duty, U.S. Army medics (military occupational specialty 68W) without additional advanced medical training were randomly assigned to use either the MLH (n = 14) or TM (n = 15) technique to identify the CTM on a standardized live female model. Success was defined as a mark within the cephalad and caudal borders of the CTM and within 5 mm of midline. Secondary outcomes included time to task completion, distance from CTM borders, horizontal deviation from midline, and participant confidence (measured via 10-cm visual analog scale). Data were analyzed using Fisher's exact test and Wilcoxon rank-sum tests.

There was no statistically significant difference in CTM identification success between the MLH (36%) and TM (33%) groups (P > .99). Secondary outcomes also showed no significant differences, including vertical and horizontal deviation, time to task completion (median MLH: 19.34 s vs TM: 12.97 s; P = .057), and confidence (median MLH: 7.0 vs TM: 8.0; P = .53).

U.S. Army medics demonstrated similarly low accuracy in CTM identification in a female model using both the MLH and TM techniques. These findings highlight the need for enhanced training protocols that consider sex-specific anatomical challenges to optimize cricothyrotomy success in prehospital battlefield settings.