A bench study comparing between scalpel-bougie technique and cannula-to-Melker technique in emergency cricothyroidotomy in a porcine model

다국어 초록 (Multilingual Abstract)

Background: The ideal emergency cricothyroidotomy technique remains a topic of ongoing debate. This study aimed to compare the cannula-to-Melker technique with the scalpel-bougie technique and determine whether yearly training in cricothyroidotomy techniques is sufficient for skill retention.
Methods: We conducted an observational crossover bench study to compare the cannula-to-Melker with the scalpel- bougie technique in a porcine tracheal model. Twenty-eight anesthetists participated. The primary outcome was time taken for device insertion. Secondary outcomes were first-pass success rate, incidence of tracheal trauma, and technique preference. We also compared the data on outcome measures with the data obtained in a similar workshop a year ago.
Results: The scalpel-bougie technique was significantly faster than the cannula-to-Melker technique for cricothyroidotomy (median time of 45.2 s vs. 101.3 s; P = 0.001). Both techniques had 100% success rate within two attempts; there were no significant differences in the first-pass success rates and incidence of tracheal wall trauma (P > 0.999 and P = 0.727, respectively) between them. The relative risks of inflicting tracheal wall trauma after a failed cricothyroidotomy attempt were 6.9 (95% CI 1.5–31.1), 2.3 (95% CI 0.3–20.7) and 3.0 (95% CI 0.3–25.9) for the scalpel-bougie, cannula-cricothyroidotomy, and Melker-Seldinger airway, respectively. The insertion time and incidence of tracheal wall trauma were lower when the present data were compared with data from a similar workshop conducted the previous year.
Conclusions: This study supports the use of a scalpel-bougie technique for cricothyroidotomy by anesthetists and advocates a yearly training program for skill retention.

참고문헌 (Reference)

1 Wong DT, "What is the minimum training required for successful cricothyroidotomy?: a study in mannequins" 98 : 349-353, 2003

2 Baker PA, "The great airway debate: is the scalpel mightier than the cannula" 117 (117): i17-i19, 2016

3 Heard AM, "The formulation and introduction of a 'can't intubate, can't ventilate' algorithm into clinical practice" 64 : 601-608, 2009

4 Law JA, "The difficult airway with recommendations for management-part 1-difficult tracheal intubation encountered in an unconscious/induced patient" 60 : 1089-1118, 2013

5 Chrisman L, "Surgicric 2: a comparative bench study with two established emergency cricothyroidotomy techniques in a porcine model" 117 : 236-242, 2016

6 Heard A, "Percutaneous emergency oxygenation strategies in the 'can't intubate, can't oxygenate' scenario [Internet]"

7 Cook TM, "Management of the 'can't intubate can't ventilate' situation and the emergency surgical airway. In: Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Major Complications of Airway Management in the United Kingdom. Report and Findings" Royal College of Anaesthetists 105-113, 2011

8 Des Jarlais DC, "Improving the reporting quality of nonrandomized evaluations of behavioral and public health interventions: the TREND statement" 94 : 361-366, 2004

9 Hamaekers AE, "Equipment and strategies for emergency tracheal access in the adult patient" 66 (66): 65-80, 2011

10 Frerk C, "Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults" 115 : 827-848, 2015

11 Cook TM, "Complications and failure of airway management" 109 (109): i68-i85, 2012

12 Wong DT, "Cannot intubate-cannot ventilate and difficult intubation strategies: results of a Canadian national survey" 100 : 1439-1446, 2005

13 Hubble MW, "A meta-analysis of prehospital airway control techniques part II: alternative airway devices and cricothyrotomy success rates" 14 : 515-530, 2010