Comparison of three cuffed emergency percutaneous cricothyroidotomy devices to conventional surgical cricothyroidotomy in a porcine model.
Murphy, C Rooney, S J Maharaj, C H Laffey, J G Harte, B H
Murphy, C
Rooney, S J
Maharaj, C H
Laffey, J G
Harte, B H
Advisors
Editors
Other Contributors
Date
2011-01
Date Submitted
Keywords
Other Subjects
Subject Mesh
Animals
Cricoid Cartilage
Emergencies
Equipment Design
Models, Animal
Respiration, Artificial
Sus scrofa
Thyroid Cartilage
Tracheostomy
Cricoid Cartilage
Emergencies
Equipment Design
Models, Animal
Respiration, Artificial
Sus scrofa
Thyroid Cartilage
Tracheostomy
Planned Date
Start Date
Collaborators
Principal Investigators
Alternative Titles
Publisher
Abstract
Emergency cricothyroidotomy is a potentially life-saving procedure in the 'cannot intubate cannot ventilate (CICV)' scenario. Although surgical cricothyroidotomy remains the technique recommended in many 'CICV' algorithms, the insertion of a tracheostomy as a cannula over a trocar, or using the Seldinger method, may have advantages as they are more familiar to the anaesthetist. We compared the utility of three cuffed cricothyroidotomy devices: cuffed Melker®, Quicktrach 2®, and PCK® devices, with surgical cricothyroidotomy.
After ethical committee approval and written informed consent, 20 anaesthetists performed cricothyroidotomy with all four devices in random order, in a pig larynx and trachea model covered in cured pelt. The primary endpoints were the rate of successful placement of the cricothyroidotomy device into the trachea and the duration of the insertion attempt.
The Melker® and Quicktrach 2® devices possessed advantages over the surgical approach, in contrast to the PCK® device, which performed less well. All 20 participants inserted the Melker®, with 19 being successful using the surgical approach and the Quicktrach 2®, whereas only 12 successfully inserted the PCK® device (PCK® vs surgical, P=0.02). The Quicktrach 2® had the fastest insertion times and caused least trauma to the posterior tracheal wall. The Melker® was rated highest by the participants and was the only device rated higher than the surgical technique.
The Melker® and Quicktrach 2® devices appear to hold particular promise as alternatives to surgical cricothyroidotomy. Further studies, in more clinically relevant models, are required to confirm these initial positive findings.
After ethical committee approval and written informed consent, 20 anaesthetists performed cricothyroidotomy with all four devices in random order, in a pig larynx and trachea model covered in cured pelt. The primary endpoints were the rate of successful placement of the cricothyroidotomy device into the trachea and the duration of the insertion attempt.
The Melker® and Quicktrach 2® devices possessed advantages over the surgical approach, in contrast to the PCK® device, which performed less well. All 20 participants inserted the Melker®, with 19 being successful using the surgical approach and the Quicktrach 2®, whereas only 12 successfully inserted the PCK® device (PCK® vs surgical, P=0.02). The Quicktrach 2® had the fastest insertion times and caused least trauma to the posterior tracheal wall. The Melker® was rated highest by the participants and was the only device rated higher than the surgical technique.
The Melker® and Quicktrach 2® devices appear to hold particular promise as alternatives to surgical cricothyroidotomy. Further studies, in more clinically relevant models, are required to confirm these initial positive findings.
Language
en
ISSN
1471-6771
eISSN
ISBN
DOI
10.1093/bja/aeq294
PMID
21037267