Comparison of 2 cricothyrotomy techniques: Standard method versus rapid 4-step technique

James F Holmes Jr, Edward A Panacek, J. C. Sakles, B. T. Brofeldt

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70 Citations (Scopus)

Abstract

Study objective: To compare the success rate, complication rate and time required for the rapid 4-step technique versus the standard technique for cricothyrotomy. Methods: We conducted a prospective, randomized crossover study. Twenty-seven emergency medicine interns, 1 junior medicine resident, and 4 senior medical students, without prior cricothyrotomy experience, were randomly divided into 2 groups. Group 1 was initially instructed in and then performed the standard technique; group 2 was initially instructed in and then performed the rapid 4-step technique. Each group was then instructed in and performed the alternate method. Cricothyrotomies were performed on preserved human cadavers. Results: A surgical airway was established in 28 of 32 attempts with the use of the rapid 4-step technique (88%); the average time elapsed before tube placement was 43 seconds. Thirty of 32 attempts involving the standard technique (94%) were successful; the average time to tube placement was 134 seconds (95% confidence interval for a difference of 91 seconds, 63 to 119; P<.001). Complications were identified in 12 attempts involving the standard technique (38%; 1 considered major) and in 12 involving the rapid four-step technique (38%; 3 considered major). The incidence of major complications was 6% higher for the rapid 4-step technique (95% confidence interval, -9% to 21%). Conclusion: In a group of inexperienced subjects working on a preserved human cadaver model, the rapid 4-step technique for cricothyrotomy was performed in about one third the time required for performance of the standard technique. This finding was both clinically and statistically significant. Although the 2 techniques had similar success and complication rates, we noted a trend toward more severe complications in the rapid 4-step technique.

Original languageEnglish (US)
Pages (from-to)442-447
Number of pages6
JournalAnnals of Emergency Medicine
Volume32
Issue number4
DOIs
StatePublished - 1998

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Cadaver
Confidence Intervals
Emergency Medicine
Medical Students
Cross-Over Studies
Medicine
Incidence

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Comparison of 2 cricothyrotomy techniques : Standard method versus rapid 4-step technique. / Holmes Jr, James F; Panacek, Edward A; Sakles, J. C.; Brofeldt, B. T.

In: Annals of Emergency Medicine, Vol. 32, No. 4, 1998, p. 442-447.

Research output: Contribution to journalArticle

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abstract = "Study objective: To compare the success rate, complication rate and time required for the rapid 4-step technique versus the standard technique for cricothyrotomy. Methods: We conducted a prospective, randomized crossover study. Twenty-seven emergency medicine interns, 1 junior medicine resident, and 4 senior medical students, without prior cricothyrotomy experience, were randomly divided into 2 groups. Group 1 was initially instructed in and then performed the standard technique; group 2 was initially instructed in and then performed the rapid 4-step technique. Each group was then instructed in and performed the alternate method. Cricothyrotomies were performed on preserved human cadavers. Results: A surgical airway was established in 28 of 32 attempts with the use of the rapid 4-step technique (88{\%}); the average time elapsed before tube placement was 43 seconds. Thirty of 32 attempts involving the standard technique (94{\%}) were successful; the average time to tube placement was 134 seconds (95{\%} confidence interval for a difference of 91 seconds, 63 to 119; P<.001). Complications were identified in 12 attempts involving the standard technique (38{\%}; 1 considered major) and in 12 involving the rapid four-step technique (38{\%}; 3 considered major). The incidence of major complications was 6{\%} higher for the rapid 4-step technique (95{\%} confidence interval, -9{\%} to 21{\%}). Conclusion: In a group of inexperienced subjects working on a preserved human cadaver model, the rapid 4-step technique for cricothyrotomy was performed in about one third the time required for performance of the standard technique. This finding was both clinically and statistically significant. Although the 2 techniques had similar success and complication rates, we noted a trend toward more severe complications in the rapid 4-step technique.",
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N2 - Study objective: To compare the success rate, complication rate and time required for the rapid 4-step technique versus the standard technique for cricothyrotomy. Methods: We conducted a prospective, randomized crossover study. Twenty-seven emergency medicine interns, 1 junior medicine resident, and 4 senior medical students, without prior cricothyrotomy experience, were randomly divided into 2 groups. Group 1 was initially instructed in and then performed the standard technique; group 2 was initially instructed in and then performed the rapid 4-step technique. Each group was then instructed in and performed the alternate method. Cricothyrotomies were performed on preserved human cadavers. Results: A surgical airway was established in 28 of 32 attempts with the use of the rapid 4-step technique (88%); the average time elapsed before tube placement was 43 seconds. Thirty of 32 attempts involving the standard technique (94%) were successful; the average time to tube placement was 134 seconds (95% confidence interval for a difference of 91 seconds, 63 to 119; P<.001). Complications were identified in 12 attempts involving the standard technique (38%; 1 considered major) and in 12 involving the rapid four-step technique (38%; 3 considered major). The incidence of major complications was 6% higher for the rapid 4-step technique (95% confidence interval, -9% to 21%). Conclusion: In a group of inexperienced subjects working on a preserved human cadaver model, the rapid 4-step technique for cricothyrotomy was performed in about one third the time required for performance of the standard technique. This finding was both clinically and statistically significant. Although the 2 techniques had similar success and complication rates, we noted a trend toward more severe complications in the rapid 4-step technique.

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