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To stab or slash: the percutaneous dilatation or standard surgical approach to cricothyroidotomy in prehospital care
  1. Ian Jones, Registered Paramedic,
  2. Katherine Roberts, Research officer
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; kevin.mackway-jones{at}man.ac.uk

    Abstract

    A short cut review was carried out to establish whether surgical or percutaneous dilatation techniques offer better success rates in emergency cricothyroidotomy. Altogether 114 papers were found using the reported search, of which two presented the best evidence to answer the clinical question. The author, date, and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.

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    Report by Ian Jones,Registered ParamedicChecked by Katherine Roberts, Research officer

    Clinical scenario

    A paramedic ambulance is dispatched to a 24 year old man who has been ejected through the windscreen of his car. On arrival at the scene the patient is found to have major maxillofacial injuries with a seriously compromised airway. Airway control cannot be achieved by manual techniques and endotracheal intubation is not possible. You decide to attempt cricothyroidotomy and wonder whether the surgical technique is preferable to the percutaneous dilatation technique.

    Three part question

    In an [adult requiring emergency cricothyroidotomy] is [the standard surgical approach more effective than a percutaneous dilatation method] at [achieving an open airway and minimising complications]?

    Search strategy

    Medline 1966–06/02 using the OVID interface. [{cricothyroid.mp OR surgical airway.mp} AND {percutaneous.mp OR needle.mp OR surgical}] LIMIT to human AND English.

    Search outcome

    Altogether 144 papers found of which 142 were irrelevant to the study. The two remaining papers are shown in table 8.

    Table 8

    Comment(s)

    The study by Johnson et al found statistically significant differences in the insertion times and the subjective ease of use of the procedure, which were both in favour of the surgical approach. This study was of a lower quality than the Eisenburger study, which found no statistically significant differences between the techniques.

    CLINICAL BOTTOM LINE

    There is no convincing evidence that either technique is superior in the prehospital environment. The operator should use the technique with which they are most familiar.

    Report by Ian Jones,Registered ParamedicChecked by Katherine Roberts, Research officer

    References

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