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Emergency cricothyroidotomy performed by inexperienced clinicians—surgical technique versus indicator-guided puncture technique
  1. Matthias Helm1,
  2. Björn Hossfeld1,
  3. Christian Jost1,
  4. Lorenz Lampl1,
  5. Tobias Böckers2
  1. 1Department of Anaesthesiology and Intensive Care Medicine—Section Emergency, Medicine/Federal Armed Forces Medical Centre, Ulm, Germany
  2. 2Institute of Anatomy and Cell Biology, School of Medicine/University of Ulm, Ulm, Germany
  1. Correspondence to Dr Matthias Helm, Department of Anaesthesiology and Intensive Care Medicine, Section Emergency Medicine, Federal Armed Forces Medical Centre, Oberer Eselsberg 40, 89070 Ulm, Germany; matthias.helm{at}


Background To improve the ease and safety of cricothyroidotomy especially in the hand of the inexperienced, new instruments have been developed. In this study, we compared a new indicator-guided puncture technique (PCK) with standard surgical technique (ST) regarding success rate, performance time and complications.

Methods Cricothyroidotomy in 30 human cadavers performed by 30 first year anaesthesia residents. The set chosen for use was randomised: PCK-technique (n=15) and ST (n=15). Success rates, insertion times and complications were compared. Traumatic lesions were anatomically confirmed after dissection.

Results The ST-group had a higher success rate (100% vs 67%; p=0.04). There was no difference in time taken to complete the procedure (PCK 82 s. vs ST 95 s.; p=0.89). There was a higher complication rate in the PCK-group (67% vs 13%; p=0.04). Most frequent complication in the PCK-group was injury to the posterior tracheal wall (n=8), penetration to the oesophageal lumen (n=4) and injury to the thyroid and/or cricoid cartilage (n=5). In the ST-group in only 2 cases minor complications were observed (small vessel injury).

Conclusions In this human cadaver study the PCK technique produced more major complications and more failures than the ST. In the hand of the inexperienced operator the standard surgical approach seems to be a safe procedure, which can successfully be performed within an adequate time. The PCK technique cannot be recommended for inexperienced operators.

  • Cricothyroidotomy
  • difficult airway management
  • puncture technique
  • standard surgical technique
  • surgical airway
  • airway
  • anaesthesia
  • management
  • training
  • equipment evaluation
  • emergency departments

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  • Competing interests None.

  • Ethics approval Ethics approval was provided by Local ethics committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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