Bougie‐guided Cricothyrotomy Technique

Reardon, Rob; Joing, Scott; Hill, Chandler

doi:10.1111/j.1553-2712.2009.00638.x

Cited by 10 publications

(4 citation statements)

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“…Other techniques for rapid, reliable placement in the setting of obscured anatomy are insertion of a flexible ET tube stylet into the trachea with a tube “railroaded” over it, or use of a cutdown 6.0-mm ET tube with a preloaded stylet secured just beyond the tip, which is inserted as a unit before removing the stylet. Morris et al 33 and others 50 ,69–71 have described the bougie as a similar cricothyrotomy introducer with good result. The bougie may even assist cricothyrotomy when wearing night-vision goggles, although close range visual acuity with night-vision goggles poses challenges on its own.…”

Section: Improvised Cricothyrotomymentioning

confidence: 93%

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Optimizing Emergent Surgical Cricothyrotomy for use in Austere Environments

Hessert

Bennett

2013

Wilderness & Environmental Medicine

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Emergent cricothyrotomy is an infrequently performed procedure used in the direst of circumstances on the most severely injured patients. Austere environments present further unique challenges to effective emergency medical practice. Recently, military trauma registry data were searched for the frequency of cricothyrotomy use and success rates during a 22-month period. These data revealed that cricothyrotomy performed in the most rigorous austere environment (ie, battlefield) had many successes, but also a large number of failed (33%) attempts by medics owing to many factors. Thus, the aim of this review article is to present what is known about cricothyrotomy and apply this knowledge to any austere environment for qualified providers. The National Library of Medicine's PubMed was used to conduct a thorough search using the terms "prehospital," "cricothyroidotomy," "cricothyrotomy," and "surgical airway." The findings were further narrowed by applicability to the austere environment. This review presents relevant airway anatomy, incidences, indications, contraindications, procedures, and equipment, including improvised devices, success rates, complications, and training methods. Recommendations are proffered for ways to optimize procedures, equipment, and training for successful application of this emergent skill set in the austere environment.

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Section: Improvised Cricothyrotomymentioning

confidence: 93%

“…The recommended fast and simple cricothyrotomy 3-step procedure algorithm is outlined in Figure 2, and is developed based on the studies by MacIntyre et al, 32 DiGiacomo et al, 39 and others. 50 ,69–71 Rigorous attention to these recommendations will optimize success and minimize complications in austere environments.…”

Section: Recommendationsmentioning

confidence: 99%

Optimizing Emergent Surgical Cricothyrotomy for use in Austere Environments

Hessert

Bennett

2013

Wilderness & Environmental Medicine

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“…A size 6 cuffed Shiley tracheostomy tube was originally proposed for the rapid four‐step surgical cricothyroidotomy . This 6.0‐mm internal ID tube has an 11‐mm OD and a distal length of 49 mm, and therefore has a shorter length, larger OD and surface flanges that restrict the length of intubation compared with a size 6.0‐mm ID tracheal tube (8.2‐mm OD) . In a cadaver study of standard surgical cricothyroidotomy with cephalad tracheal hook retraction, compared with the rapid four‐step technique using caudal tracheal hook retraction, it was found that there was no significant difference in tubes passing with internal diameters of 6.0, 7.0, 7.5 and 8.0 mm .…”

Section: Discussionmentioning

confidence: 99%

Parker Flex‐Tip or standard tracheal tube for percutaneous emergency airway access?

Baker

Fernández

Hamaekers

et al. 2012

Acta Anaesthesiol Scand

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“…The cricothyroidotomy is a life-saving procedure performed as a final option in all emergency airway algorithms [31, 32]. It represents an ideal prototype to evaluate the utility of DP + ML in skill acquisition and retention as it is rare, time-sensitive, and relevant across most acute care, hospital-based specialties [31, 33–36]. Furthermore, the recent introduction of a novel technique—the bougie-assisted cricothyroidotomy (BAC)—offers additional opportunity as residents are unlikely to have previous training or experience.…”

Section: Introductionmentioning

confidence: 99%

Perfecting practice: a protocol for assessing simulation-based mastery learning and deliberate practice versus self-guided practice for bougie-assisted cricothyroidotomy performance

Petrosoniak

Gray

et al. 2019

BMC Med Educ

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Background Simulation-based medical education (SBME) is a cornerstone for procedural skill training in residency education. Multiple studies have concluded that SBME is highly effective, superior to traditional clinical education, and translates to improved patient outcomes. Additionally it is widely accepted that mastery learning, which comprises deliberate practice, is essential for expert level performance for routine skills; however, given that highly structured practice is more time and resource-intensive, it is important to assess its value for the acquisition of rarely performed technical skills. The bougie-assisted cricothyroidotomy (BAC), a rarely performed, lifesaving procedure, is an ideal skill for evaluating the utility of highly structured practice as it is relevant across many acute care specialties and rare – making it unlikely for learners to have had significant previous training or clinical experience. The purpose of this study is to compare a modified mastery learning approach with deliberate practice versus self-guided practice on technical skill performance using a bougie-assisted cricothyroidotomy model. Methods A multi-centre, randomized study will be conducted at four Canadian and one American residency programs with 160 residents assigned to either mastery learning and deliberate practice (ML + DP), or self-guided practice for BAC. Skill performance, using a global rating scale, will be assessed before, immediately after practice, and 6 months later. The two groups will be compared to assess whether the type of practice impacts performance and skill retention. Discussion Mastery learning coupled with deliberate practice provides systematic and focused feedback during skill acquisition. However, it is resource-intensive and its efficacy is not fully defined. This multi-centre study will provide generalizable data about the utility of highly structured practice for technical skill acquisition of a rare, lifesaving procedure within postgraduate medical education. Study findings will guide educators in the selection of an optimal training strategy, addressing both short and long term performance.

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Bougie‐guided Cricothyrotomy Technique

Cited by 10 publications

References 0 publications

Optimizing Emergent Surgical Cricothyrotomy for use in Austere Environments

Optimizing Emergent Surgical Cricothyrotomy for use in Austere Environments

Parker Flex‐Tip or standard tracheal tube for percutaneous emergency airway access?

Perfecting practice: a protocol for assessing simulation-based mastery learning and deliberate practice versus self-guided practice for bougie-assisted cricothyroidotomy performance

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