Emergency cricothyrotomy in confined space airway emergencies: a comparison.

Introduction: In confined-space airway emergencies, prehospital personnel may need to perform cricothyrotomy when conventional airway techniques cannot be utilized or have failed. This study is a prospective, cross-over, randomized controlled trial that compares two widely-known techniques using two commercially available kits.

Methods: Twenty residents at Palmetto Health Richland Department of Emergency Medicine participated in the study. Their performance was assessed using the time required to placement and correctness of placement for each device. The residents performed the procedures on an Air-Man™ manikin that had been situated in a confined space.The residents also indicated which kit they would prefer in a confined-space, emergency airway situation.

Results: All of the devices were placed in the airway. The mean time to placement for the Melker™ and Quicktrach™ kits was 108.5 seconds and 23.9 seconds, respectively. This yielded a mean difference of 84.5 seconds, which provided a t-statistic of 8.88 (p < 0.0001).There was no evidence of a carry-over effect (p = 0.292) or a period effect (p = 0.973). All residents preferred using the Quicktrach™ kit.

Conclusions: Use of the Quicktrach™ kit resulted in the fastest time to placement, was placed correctly in the airway, and was preferred by each of the residents. Its small, simple,and sturdy design, with few parts and easy manipulation, allow the Quicktrach™ to be a valuable option in prehospital situations involving confined spaces. The Melker™ kit, with its many parts, and need for greater manipulation, is not as easily utilized or preferred in a confined space scenario.