Evaluation of the rapid four-step cricothyrotomy technique: An interim report

Introduction: We described the rapid four-step cricothyrotomy technique (RFST), a new cricothyrotomy method specifically designed for the prehospital environment. In this article, we report our initial clinical experience and provide additional information regarding the technique itself. Method: This article is a prospective, consecutive case series. Each time Life Flight personnel used the RFST in the prehospital setting, they were asked to complete a brief questionnaire regarding their experiences with the technique. Data were collected between July 1995 and June 1997. Results: During the study period, 13 cricothyrotomies were performed using the RFST, all of which were successful. One report of significant bleeding occurred and was controlled with cricoid pressure. In 4 of the 13 patients, the skin and soft tissue were incised before performing the stab incision through the cricothyroid membrane. In nine cases the incision was enlarged before passing the tracheostomy tube. A second attempt was needed to successfully pass the tube in two patients. No difficulties were reported in maneuvering the hook, and the #20 scalpel blade was thought to be an appropriate size. All personnel with previous cricothyrotomy experience preferred the RFST to their previous cricothyrotomy approach. Conclusion: Our experience with the RFST has been very favorable. We recommend this technique to others for use in the prehospital environment. We also invite the reader to participate in ongoing evaluation comparing the RFST with standard cricothyrotomy techniques.