Surgicric 2: A comparative bench study with two established emergency cricothyroidotomy techniques in a porcine model

Chrisman, L.; King, Wendy; Wimble, Katie; Cartwright, Simon; Mohammed, Kabir; Patel, Bhavesh

doi:10.1093/bja/aew174

Cited by 28 publications

(13 citation statements)

References 28 publications

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“…Although there was an added step of inserting the introducer following scalpel incision, the insertion times were significantly faster in this simulated obese model. However, the times taken in this study was longer and required more insertion attempts compared with the cricothyroidotomy studies previously conducted in our institution on a similar porcine model, but with only a thin overlying layer of skin. This correlates with the knowledge that cricothyroidotomy is technically more challenging and demanding in obese subjects, as observed in a previous simulated obese neck study .…”

Section: Discussionmentioning

confidence: 78%

“…We calculated that we would need a sample size of at least 25 participants to show whether the insertion times for a pair of devices differed by more than a threshold value of 45 s and standard deviation of difference of around 80, using a two‐sided, 5% significance level and 80%, based on two studies comparing cricothyroidotomy techniques conducted in our institution . We used the Wilcoxon matched pairs signed‐rank test to analyse the results (non‐normal distributions) and the McNemar test to compare the success rate, occurrence of false passage and identification of cricothyroid membrane.…”

Section: Methodsmentioning

confidence: 99%

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Evaluation of a novel cricothyroidotomy introducer in a simulated obese porcine model: a randomised crossover comparison with scalpel cricothyroidotomy

et al. 2018

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The Difficult Airway Society 2015 guidelines for management of unanticipated difficulties in tracheal intubation in adults have generated much discussion regarding Plan D: emergency front-of-neck access with a scalpel-bougie cricothyroidotomy technique. There is concern that this technique may not provide an adequate pathway for the bougie and subsequently the tracheal tube, especially in obese patients with deeper airway structures. This could lead to the formation of a false passage, trauma and failure. A novel cricothyroidotomy introducer, 8 mm wide and 170 mm long, with a sharp leading edge and guiding channel to pass a bougie into the trachea, has been designed to complement the scalpel cricothyroidotomy technique. A comparison study of the use of this novel introducer with the scalpel technique in a simulated obese porcine laryngeal model demonstrated shorter insertion times (median (IQR [range]) 85 (65-123 [48-224]) s vs. 84 (72-184 [46-377]) s, p = 0.030). All 26 (100%) participants successfully performed cricothyroidotomy in the introducer group, whereas only 24 (92%) participants were successful in the scalpel group. The introducer group required fewer attempts to access the trachea compared with the scalpel group (p = 0.046). False passages occurred eight (31%) times in the introducer group compared with 17 (65%) times in the scalpel group (p = 0.022). There were no statistical differences in tracheal trauma (p = 0.490), ease of use (p = 0.220) and device preference (p = 0.240). This novel cricothyroidotomy introducer has shown promising results in securing the airway in an emergency front-of-neck access situation. With robust training, this introducer could potentially be complementary to the scalpel-bougie cricothyroidotomy technique.

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Section: Discussionmentioning

confidence: 78%

Section: Methodsmentioning

confidence: 99%

Evaluation of a novel cricothyroidotomy introducer in a simulated obese porcine model: a randomised crossover comparison with scalpel cricothyroidotomy

et al. 2018

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“…The study power calculations were performed based on cricothyroidotomy procedural time. Based on a similar study [8], we derived the standard deviation of 29 s. To demonstrate a difference of 20 s as described in our previous work [9], for a power of 0.9, with a significance level of 0.05, 50 participants were needed in each group. The differences in procedural times and heart rates were analysed using the paired Student t-test.…”

Section: Methodsmentioning

confidence: 99%

Effect of palpable vs. impalpable cricothyroid membranes in a simulated emergency front‐of‐neck access scenario

et al. 2018

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The Difficult Airway Society 2015 guidelines recommend and describe in detail a surgical cricothyroidotomy technique for the can't intubate, can't oxygenate (CICO) scenario, but this can be technically challenging for anaesthetists with no surgical training. Following a structured training session, 104 anaesthetists took part individually in a simulated can't intubate, can't oxygenate event using simulation and airway models to evaluate how well they could perform these front-of-neck access techniques. Main outcomes measures were: ability to correctly perform the technical steps; procedural time; and success rate. Outcomes were compared between palpable and impalpable cricothyroid membrane scenarios. Anaesthetists' technical abilities were good, as assessed by a video analysis checklist score. Mean (SD) procedural time was 44 (16) s and 65 (17) s for the palpable and impalpable cricothyroid membrane models, respectively (p ≤ 0.001). First-pass tracheal tube placement was obtained in 103 out of the 104 palpable cricothyroidotomies and in 101 out of the 104 impalpable cricothyroidotomies (p = 0.31). We conclude that anaesthetists can be trained to perform surgical front-of-neck access to an acceptable level of competence and speed when assessed using a simulator.

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“…Studies using cadavers and animal models have shown that, compared with percutaneous cricothyrotomy (with Seldinger or Trocar method), surgical cricothyrotomy was associated with a higher success rate and a lower incidence of complications [38,39]. Because of these reasons, it is now recommended that surgical cricothyrotomy should be regarded as the most reliable method, and should be learned and regularly rehearsed by all anesthesiologists [4,40].…”

Section: 'Rescue Device'mentioning

confidence: 99%

Progress in difficult airway management

Asai

2017

J Anesth

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Surgicric 2: A comparative bench study with two established emergency cricothyroidotomy techniques in a porcine model

Abstract: This study supports training in and the use of surgical cricothyroidotomy by anaesthetists.

Cited by 28 publications

References 28 publications

Evaluation of a novel cricothyroidotomy introducer in a simulated obese porcine model: a randomised crossover comparison with scalpel cricothyroidotomy

Evaluation of a novel cricothyroidotomy introducer in a simulated obese porcine model: a randomised crossover comparison with scalpel cricothyroidotomy

Effect of palpable vs. impalpable cricothyroid membranes in a simulated emergency front‐of‐neck access scenario

Progress in difficult airway management

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