A Comparison of Two Emergency Cricothyroidotomy Kits in Human Cadavers

Benkhadra, Mehdi; Lenfant, F.; Nemetz, Wolfgang; Anderhuber, Friedrich; Feigl, Georg; Fasel, J

doi:10.1213/01.ane.0000296457.55791.34

Cited by 40 publications

(29 citation statements)

References 16 publications

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“…In contrast to these results, Assmann et al 6 found a success rate of 95% with the PCK device in a study using a standard cricothyroidotomy manikin with an anatomically correct airway. Benkharda et al 19 reported in a study comparing the PCK with a wire-guided technique (Melker Kit) on human cadavers a success rate of the PCK group of 80%; in this study the operators have been two experienced anaesthesiologists. Success rates regarding the standard surgical technique in previous studies using human cadavers vary between 70% and 100% 7 18 20 21.…”

Section: Discussionmentioning

confidence: 98%

Emergency cricothyroidotomy performed by inexperienced clinicians—surgical technique versus indicator-guided puncture technique

Helm¹,

Hossfeld²,

Jöst³

et al. 2012

Emerg Med J

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BackgroundTo improve the ease and safety of cricothyroidotomy especially in the hand of the inexperienced, new instruments have been developed. In this study, we compared a new indicator-guided puncture technique (PCK) with standard surgical technique (ST) regarding success rate, performance time and complications.MethodsCricothyroidotomy in 30 human cadavers performed by 30 first year anaesthesia residents. The set chosen for use was randomised: PCK-technique (n=15) and ST (n=15). Success rates, insertion times and complications were compared. Traumatic lesions were anatomically confirmed after dissection.ResultsThe ST-group had a higher success rate (100% vs 67%; p=0.04). There was no difference in time taken to complete the procedure (PCK 82 s. vs ST 95 s.; p=0.89). There was a higher complication rate in the PCK-group (67% vs 13%; p=0.04). Most frequent complication in the PCK-group was injury to the posterior tracheal wall (n=8), penetration to the oesophageal lumen (n=4) and injury to the thyroid and/or cricoid cartilage (n=5). In the ST-group in only 2 cases minor complications were observed (small vessel injury).ConclusionsIn this human cadaver study the PCK technique produced more major complications and more failures than the ST. In the hand of the inexperienced operator the standard surgical approach seems to be a safe procedure, which can successfully be performed within an adequate time. The PCK technique cannot be recommended for inexperienced operators.

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Section: Discussionmentioning

confidence: 98%

Emergency cricothyroidotomy performed by inexperienced clinicians—surgical technique versus indicator-guided puncture technique

Helm¹,

Hossfeld²,

Jöst³

et al. 2012

Emerg Med J

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“…This is due to the preservation of real characteristics and the easy manipulation that such cadavers present (Bertone et al;Eisma & Wilkinson;Healey et al, 2015). This way, the use of Thiel-embalmed cadavers has extended to various areas of surgery, particularly urological surgery (Healey et al, 2015), thyroidectomies (Eisma et al, 2011), cricothyroidotomies (Benkhadra et al, 2008), liver surgery simulations (Eisma et al, 2013a), arthroplasty (Windisch et al, 2001;Kamei et al, 2013), artery sutures (Odobescu et al, 2014;, peripheral nerve repair (Matzi et al, 2015), flap surgeries (Hassan et al, 2014a;Wolff et al, 2014), neurosurgery (Schwalenberg et al, 2010), anastomosis techniques (Hassan et al, 2014b) and their comparison with animal models. Skills development in the area of angiology and laparoscopy are an additional advantage, several studies indicating the possibility of producing a pneumoperitoneum in the patient with the aim of accurately recreating abdominal laparoscopic surgery (Giger et al, 2008;Slieker et al, 2012) at kidney level (Prasad Rai et al, 2012;Ubee et al, 2014;Rai et al, 2015).…”

Section: Authorsmentioning

confidence: 99%

Walter Thiel's Embalming Method: Review of Solutions and Applications in Different Fields of Biomedical Research

et al. 2016

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's embalming method. Review of solutions and applications in different fields of biomedical research. Int. J. Morphol., 34(4):1442Morphol., 34(4): -1454Morphol., 34(4): , 2016. SUMMARY:Walter Thiel developed the method that enables preservation of the body with natural colors in 1992. It consists in the application of an intravascular injection formula, and maintaining the corps submerged for a determinate period of time in the immersion solution in the pool. After immersion, it is possible to maintain the corps in a hermetically sealed container, thus avoiding dehydration outside the pool. The aim of this work was to review the Thiel method, searching all scientific articles describing this technique from its development point of view, and application in anatomy and morphology teaching, as well as in clinical and surgical practice. Most of these studies were carried out in Europe. We used PubMed, Ebsco and Embase databases with the terms "Thiel cadaver", "Thiel embalming", "Thiel embalming method" and we searched for papers that cited Thiel`s work. In comparison with methods commonly used with high concentrations of formaldehyde, this method lacks the emanation of noxious or irritating gases; gives the corps important passive joint mobility without stiffness; maintaining color, flexibility and tissue plasticity at a level equivalent to that of a living body. Furthermore, it allows vascular repletion at the capillary level. All this makes for great advantage over the formalinfixed and fresh material. Its multiple uses are applicable in anatomy teaching and research; teaching for undergraduates (prosection and dissection) and for training in surgical techniques for graduates and specialists (laparoscopies, arthroscopies, endoscopies).

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“…Many simulations, including human cadavers, plastic mannequins, animal larynx, and live animals, have been used as a surrogate for the human larynx. [12][13][14][15][16][17] Fresh human cadaver is considered the simulation with the highest degree of fidelity to teach and evaluate cricothyrotomy skills; however, supply and ethical considerations limit its availability. The porcine larynx is considered an acceptable model with anatomical structures similar to the human neck 11 and is frequently employed in cricothyrotomy studies.…”

Section: Discussionmentioning

confidence: 99%

“…12 The Portex 6.0 kit (Smiths Medical, Markham, ON, Canada) uses a tube-over-trocar technique with a red flag indication. 13 Since the two different techniques (i.e., Seldinger and tube-over-trocar) have been shown to affect performances, 13,14 each participant performed a cricothyrotomy with each of the two techniques using either the Portex 6.0 and Melker 3.5 cricothyrotomy kits or the Portex 6.0 and Melker 5.0 kits.…”

Section: Cricothyrotomy Devicesmentioning

confidence: 99%

Role of contextualizing a crisis scenario on the performance of a cricothyrotomy procedural task

You-Ten

Wong

Arzola

et al. 2015

Can J Anesth/J Can Anesth

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Purpose Simulation is an important alternative to evaluate cricothyrotomy, a rare life-saving procedure. This crossover study aimed to determine whether contextualization of a crisis scenario would impact the performance of a cricothyrotomy procedural task. Methods Sixty-five anesthesia assistants and emergency medicine and anesthesia residents underwent a teaching session in surgical cricothyrotomy using one of two sets of cricothyrotomy kits: the Portex 6.0 and Melker 3.5 (n = 32) or the Portex 6.0 and Melker 5.0 (n = 33). Within six weeks following the session, the participants performed cricothyrotomies on a full-body patient mannequin simulator coupled with a porcine larynx (tissuemannequin simulator) using the assigned two kits in a ''cannot intubate, cannot ventilate'' (CICV) contextualized scenario (CS) and in a CICV verbalized non-contextualized scenario (NCS). Each participant performed a total of four cricothyrotomies using the two kits in the two scenarios. The primary outcome measure was insertion time, and secondary outcome measures were severity of injuries and failure rate. Outcome measures were compared between scenarios for each kit. Results Mean (SD) insertion time for a successful cricothyrotomy was not significantly different between NCS and CS for the Melker 3.5 [83.0 (45.0) sec vs 63.3 (36.1) sec, respectively; P = 0.96; mean difference (MD), 19.7 sec; 95% confidence interval (CI), -1.9 to 41.3], the Melker 5.0 [86.5 (36.8) sec vs 107.1 (55.6) sec, respectively; P = 0.11; MD, -20.6 sec; 95% CI, -44.9 to 3.7], and the Portex 6.0 [59.5 (35.5) sec vs 59.0 (35.0) sec, respectively; P = 0.95; MD, 0.5 sec; 95% CI, -13.2 to 14.2]. Failure rate and severity of injuries, measured as mean average injury score for each kit, were also similar between scenarios. Conclusions Contextualization of a crisis scenario did not affect the performance of a cricothyrotomy procedural task on a tissue-mannequin simulator. These findings may have implications when considering the feasibility and cost-effectiveness for assessing the performance of cricothyrotomy procedural tasks. RésuméObjectif La simulation est une alternative importante pour évaluer la cricothyrotomie, une intervention de sauvetage rare. Cette étude croisée avait pour objectif de déterminer si la mise en contexte d'un scénario de crise avait un impact sur la performance d'une tâche procédurale de cricothyrotomie.Author contributions Kong E. You-Ten designed the study, conducted the study, analyzed the data, and wrote the manuscript. Catherine Wong helped analyze the data and write the manuscript. Catherine Wong, Cristian Arzola, Jessica Cheung, and Naveed Siddiqui helped conduct the study. Catherine Wong, Cristian Arzola, Jessica Cheung, Naveed Siddiqui, Zeev Friedman, and Sev Perelman helped review the manuscript. Zeev Friedman and Sev Perelman helped design the study.

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A Comparison of Two Emergency Cricothyroidotomy Kits in Human Cadavers

Abstract: In this model, despite a shorter insertion time, the NT produced more lesions and more failures than the ST.

Cited by 40 publications

References 16 publications

Emergency cricothyroidotomy performed by inexperienced clinicians—surgical technique versus indicator-guided puncture technique

Emergency cricothyroidotomy performed by inexperienced clinicians—surgical technique versus indicator-guided puncture technique

Walter Thiel's Embalming Method: Review of Solutions and Applications in Different Fields of Biomedical Research

Role of contextualizing a crisis scenario on the performance of a cricothyrotomy procedural task

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