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A comparison of three techniques for cricothyrotomy on a manikin

BACKGROUND: Cricothyrotomy can either be performed by an “open” cricothyrotomy technique, or by a needle (Seldinger) technique. Clinical uncertainty exists regarding which technique is more effective. We compared three different techniques for cricothyrotomy, performed by anesthesiologists on a mani...

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Autores principales: Poole, Oliver, Vargo, Michael, Zhang, JinBin, Hung, Orlando
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Canadian Society of Respiratory Therapists 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6422212/
https://www.ncbi.nlm.nih.gov/pubmed/30996627
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author Poole, Oliver
Vargo, Michael
Zhang, JinBin
Hung, Orlando
author_facet Poole, Oliver
Vargo, Michael
Zhang, JinBin
Hung, Orlando
author_sort Poole, Oliver
collection PubMed
description BACKGROUND: Cricothyrotomy can either be performed by an “open” cricothyrotomy technique, or by a needle (Seldinger) technique. Clinical uncertainty exists regarding which technique is more effective. We compared three different techniques for cricothyrotomy, performed by anesthesiologists on a manikin. METHODS: The techniques studied include an open surgical technique, the Melker Cricothyrotomy kit (Cook), and the Portex Cricothyroidotomy Kit (Smiths Medical). Participants were randomized to the order they performed each technique. Each procedure was videotaped and the time to first ventilation recorded. The participants completed a 10-point scale following the performance of all techniques to assess the subjective level of difficulty of each technique and to indicate which technique they would prefer in a real clinical CICO scenario. RESULTS: Mean time to ventilation was significantly faster with the surgical cricothyrotomy technique, when compared with both the Portex and Melker techniques (Mean difference: Portex–surgical = 18 s, 95% CI (1, 36) and Melker–surgical = 42 s, 95% CI (31, 54)). The Portex technique was significantly faster than the Melker technique (Melker–Portex = 24 s, 95% CI (11, 37)). Six of the 11 (55%) participants preferred the Melker procedure, four (36%) preferred the surgical procedure, and only one anesthesiologist (9%) preferred the Portex procedure. DISCUSSION: The surgical technique was faster than both the Portex and Melker techniques. The surgical technique was also more successful than the Melker technique. The preferred technique among the participants was the Melker technique, despite being the slowest, least successful, and rated most difficult by participants and observers. This suggests that although the surgical technique may not be preferred by many airway practitioners, it has been shown to be the most likely technique to achieve the primary goal of the procedure: establishing oxygenation and preventing death. IMPLICATION STATEMENT: This research examines three techniques for cricothyrotomy in the “Can’t Intubate, Can’t Oxygenate” scenario. Our data, as well as data from other studies, suggest that a practice shift towards a surgical technique, and away from needle based techniques, may be warranted.
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spelling pubmed-64222122019-04-17 A comparison of three techniques for cricothyrotomy on a manikin Poole, Oliver Vargo, Michael Zhang, JinBin Hung, Orlando Can J Respir Ther Research Article BACKGROUND: Cricothyrotomy can either be performed by an “open” cricothyrotomy technique, or by a needle (Seldinger) technique. Clinical uncertainty exists regarding which technique is more effective. We compared three different techniques for cricothyrotomy, performed by anesthesiologists on a manikin. METHODS: The techniques studied include an open surgical technique, the Melker Cricothyrotomy kit (Cook), and the Portex Cricothyroidotomy Kit (Smiths Medical). Participants were randomized to the order they performed each technique. Each procedure was videotaped and the time to first ventilation recorded. The participants completed a 10-point scale following the performance of all techniques to assess the subjective level of difficulty of each technique and to indicate which technique they would prefer in a real clinical CICO scenario. RESULTS: Mean time to ventilation was significantly faster with the surgical cricothyrotomy technique, when compared with both the Portex and Melker techniques (Mean difference: Portex–surgical = 18 s, 95% CI (1, 36) and Melker–surgical = 42 s, 95% CI (31, 54)). The Portex technique was significantly faster than the Melker technique (Melker–Portex = 24 s, 95% CI (11, 37)). Six of the 11 (55%) participants preferred the Melker procedure, four (36%) preferred the surgical procedure, and only one anesthesiologist (9%) preferred the Portex procedure. DISCUSSION: The surgical technique was faster than both the Portex and Melker techniques. The surgical technique was also more successful than the Melker technique. The preferred technique among the participants was the Melker technique, despite being the slowest, least successful, and rated most difficult by participants and observers. This suggests that although the surgical technique may not be preferred by many airway practitioners, it has been shown to be the most likely technique to achieve the primary goal of the procedure: establishing oxygenation and preventing death. IMPLICATION STATEMENT: This research examines three techniques for cricothyrotomy in the “Can’t Intubate, Can’t Oxygenate” scenario. Our data, as well as data from other studies, suggest that a practice shift towards a surgical technique, and away from needle based techniques, may be warranted. Canadian Society of Respiratory Therapists 2017-05-01 2017 /pmc/articles/PMC6422212/ /pubmed/30996627 Text en http://creativecommons.org/licenses/by-nc/4.0/ This open-access article is distributed under the terms of the Creative Commons Attribution Non-Commercial License (CC BY-NC) (http://creativecommons.org/licenses/by-nc/4.0/), which permits reuse, distribution and reproduction of the article, provided that the original work is properly cited and the reuse is restricted to noncommercial purposes. For commercial reuse, contact editor@csrt.com
spellingShingle Research Article
Poole, Oliver
Vargo, Michael
Zhang, JinBin
Hung, Orlando
A comparison of three techniques for cricothyrotomy on a manikin
title A comparison of three techniques for cricothyrotomy on a manikin
title_full A comparison of three techniques for cricothyrotomy on a manikin
title_fullStr A comparison of three techniques for cricothyrotomy on a manikin
title_full_unstemmed A comparison of three techniques for cricothyrotomy on a manikin
title_short A comparison of three techniques for cricothyrotomy on a manikin
title_sort comparison of three techniques for cricothyrotomy on a manikin
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6422212/
https://www.ncbi.nlm.nih.gov/pubmed/30996627
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