Comparison of conventional surgical versus Seldinger technique emergency cricothyrotomy performed by inexperienced clinicians

ackground: Cricothyrotomy is the ultimate option for a patient with a life- threatening airway problem. Methods: The authors compared the first-time performance of surgical (group 1) versus Seldinger technique (group 2) cricothyrotomy in cadavers, Intens ive care unit physicians (n = 20) performed each procedure on two adult hum an cadavers. Methods were compared with regard to ease of use and anatomy o f the neck of the cadaver. Times to location of the cricothyroid membrane, to tracheal puncture, and to the first ventilation were recorded. Each part icipant was allowed only one attempt per procedure. A pathologist dissected the neck of each patient and assessed correctness of position of the tube and any injury inflicted. Subjective assessment of technique and cadaver on a visual analog scale from 1 (easiest) to 5 (worst) was conducted by the p erformer. Results: Age, height, and weight of the cadavers were not different. Subjec tive assessment of both methods (2.2 in group 1 vs. 2.4 in group 2) and ana tomy of the cadavers (2.2 in group 1 vs. 2.4 in group 2) showed no statisti cally significant difference between both groups. Tracheal placement of the tube was achieved in 70% (n = 14) in group 1 versus 60% (n = 12) in group 2 (P value not significant). Five attempts in group 2 had to be aborted bec ause of kinking of the guide wire. Time intervals (mean +/- SD) were from s tart: to location of the cricothyroid membrane 7 +/- 9 s (group 1) versus 8 +/- 7 s (group 2), to tracheal puncture 46 +/- 37 s (group 1) versus 30 +/ - 28 s (group 2), and to first ventilation 102 +/- 42 s (group 1) versus 10 0, 46 s (group 2) (P value not significant). Conclusions: The two methods showed equally poor performance.