Cricothyrotomy in Goettingen mini-pigs: Standard surgical approach versus Nu-Trake (R) cricothyrotomy device.

Study Objective: To compare the time required, success rate and complicatio n rate of the standard surgical approach for cricothyrotomy versus a prepac ked kit in regard to the experience of the surgeon. Methods: The cricothyro tomies were performed in Goettingen mini-pigs (n=14) under general anaesthe sia. 7 different surgeons (2 Otorhinolaryngologists, 2 Emergency Physicians , 3 medical students) used each technique (standard surgical approach and N u-Trake(R) device) once to perform the cricothyrotomy without prior practic e. Results: The fastest time to do the cricothyrotomy with Nu-Trake(R) was 40 s, the slowest 93 s and the mean time of all 7 surgeons was 58 +/- 18 s. Using the standard approach it took 42s up to 154s until ventilation with a mean time of 106 +/- 48 s. The use of Nu-Trake(R) was significantly faste r than the standard surgical approach (p < 0.05, t-test). Otorhinolaryngolo gists were quicker using the standard technique (46 s versus 58 s with Nu-T rake(R)), whereas each surgeon of the other two groups (emergency physician s and medical students) was quicker with the Nu-Trake(R) Set (58 +/- 21 s) than with the conventional method (135 +/- 18 s). The number of complicatio ns was similar with both methods, but a difference was detected in the type and severity of the complication: An injury of the posterior tracheal wall was observed twice with Nu-Trake(R). Conclusions: Experienced personnel sh ould maintain the standard surgical approach for cricothyrotomy. Unexperien ced personnel can use the Nu-Trake(R) device which was found to be quicker as it facilitates the procedure, but causes more severe complications. We r ecommend to practise cricothyrotomy regularly in human cadavers, in the ani mal model if possible or on mannequins to be sufficiently trained in advanc ed airway management.