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CRITICAL CARE AND TRAUMA

A Comparison of a New Indicator-Guided with a Conventional Wire-Guided Percutaneous Cricothyroidotomy Device in Mannequins

From the Department of Anesthesiology, Toronto Western Hospital, University of Toronto, Ontario, Canada.

Address correspondence to David T. Wong, MD, Department of Anesthesia, Toronto Western Hospital, 399 Bathurst St, Toronto, ON, M5T 2S8. Address e-mail to david.wong{at}uhn.on.ca.

BACKGROUND: Percutaneous cricothyroidotomy may be a life-saving procedure in cannot intubate–cannot ventilate situations. In this study we compared the insertion times of a new indicator-guided cricothyroidotomy device and a wire-guided device in mannequins.

METHODS: This study was a crossover trial comparing the insertion times and success rates of an indicator-guided tube-over-needle device and a wire-guided cricothyroidotomy device in a mannequin. After an audiovisual training session, 64 anesthesiologists performed five cricothyroidotomies with each of the two devices. Successful insertion was defined as insertion of a device into the correct anatomic location. The insertion times and success rates between the two techniques for the five attempts were compared using repeated measures ANOVA, paired t-test, and ² analyses.

RESULTS: Insertion times were faster (32.6 ± 14.9 s vs 42.3 ± 12.5 s, P < 0.001) while success rates were similar (95% vs 93.1%) with the indicator-guided device when compared with the wire-guided device. For both devices, performance improved with repeated attempts. Four insertion attempts (1.3%) were positioned anterior or posterior to the trachea lumen with the indicator-guided device compared to none with the wire-guided device (P = 0.12) Subjectively, more participants chose to use the wire-guided than the indicator-guided device (59% vs 31%, P < 0.001) in a clinical emergency situation.

CONCLUSION: In a mannequin model, cricothyroidotomy insertion times were faster for the indicator-guided technique than for the wire-guided technique, but success rates were similar. Subjectively, more participants chose to use the wire-guided device in a clinical emergency situation.

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