Emergency Front-of-neck Access: Comparing Needle and Surgical Cricothyrotomy Using a Human Cadaver Model

Area of Science:

• Emergency Medicine
• Surgical Procedures
• Airway Management

Background:

• Emergency front-of-neck access is a critical intervention for patients with difficult airways.
• Cricothyrotomy, including needle and surgical techniques, is performed in a small percentage of airway management attempts.
• This study aimed to compare needle and surgical cricothyrotomy in terms of speed and success.

Purpose of the Study:

• To compare procedural completion time and first-pass success rates of needle versus surgical cricothyrotomy.
• To evaluate complication rates associated with both techniques.
• To assess performance across different practitioner levels (EM attendings, residents, and military Pararescue specialists).

Main Methods:

• 99 subjects (EM attendings, residents, Pararescue specialists) performed one needle or surgical cricothyrotomy on a human cadaver.
• Procedural completion time, first-pass success, and complications were recorded.
• Statistical analyses included Wilcoxon signed-rank test, Cox regression, and logistic regression, adjusting for training level.

Main Results:

• Median completion time was slightly shorter for needle cricothyrotomy (56.5 sec) versus surgical (65 sec), but the difference was not statistically significant (P=.08).
• First-pass success rates were comparable (94% for both needle and surgical).
• Complication rates were also similar between needle (27%) and surgical (33%) techniques (P=.52).

Conclusions:

• Needle and surgical cricothyrotomy demonstrated comparable performance in terms of completion time, success, and complications in this cadaver model.
• The minimal time difference is unlikely to be clinically significant.
• Both techniques remain viable options for emergency front-of-neck access in civilian and military settings, provided adequate training and equipment.