Mattinger C, Petroianu G, Maleck W, Bergler W, Hörmann K
HNO-Klinik, Universitätsklinikum Mannheim.
Laryngorhinootologie. 2000 Oct;79(10):595-8. doi: 10.1055/s-2000-7674.
To compare the time required, success rate and complication rate of the standard surgical approach for cricothyrotomy versus a prepacked kit in regard to the experience of the surgeon.
The cricothyrotomies were performed in Goettingen mini-pigs (n = 14) under general anaesthesia. 7 different surgeons (2 Otorhinolaryngologists, 2 Emergency Physicians, 3 medical students) used each technique (standard surgical approach and Nu-Trake device) once to perform the cricothyrotomy without prior practice.
The fastest time to do the cricothyrotomy with Nu-Trake 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 42 s up to 154 s until ventilation with a mean time of 106 +/- 48 s. The use of Nu-Trake was significantly faster than the standard surgical approach (p < 0.05, t-test). Otorhinolaryngologists were quicker using the standard technique (46 s versus 58 s with Nu-Trake), whereas each surgeon of the other two groups (emergency physicians and medical students) was quicker with the Nu-Trake Set (58 +/- 21 s) than with the conventional method (135 +/- 18 s). The number of complications 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.
Experienced personnel should maintain the standard surgical approach for cricothyrotomy. Inexperienced personnel can use the Nu-Trake device which was found to be quicker as it facilitates the procedure, but causes more severe complications. We recommend to practise cricothyrotomy regularly in human cadavers, in the animal model if possible or on mannequins to be sufficiently trained in advanced airway management.
就外科医生的经验而言，比较环甲膜切开术的标准手术方法与预包装套件所需的时间、成功率和并发症发生率。
在全身麻醉下，对哥廷根小型猪（n = 14）进行环甲膜切开术。7名不同的外科医生（2名耳鼻喉科医生、2名急诊科医生、3名医学生）分别使用每种技术（标准手术方法和Nu-Trake装置）进行一次环甲膜切开术，术前无练习。
使用Nu-Trake进行环甲膜切开术的最快时间为40秒，最慢为93秒，7名外科医生的平均时间为58±18秒。使用标准方法时，通气前耗时42秒至154秒，平均时间为106±48秒。使用Nu-Trake明显比标准手术方法快（p < 0.05，t检验）。耳鼻喉科医生使用标准技术更快（46秒对使用Nu-Trake的58秒），而其他两组（急诊科医生和医学生）的每位外科医生使用Nu-Trake套件（58±21秒）比使用传统方法（135±18秒）更快。两种方法的并发症数量相似，但在并发症的类型和严重程度上存在差异：使用Nu-Trake时观察到两次气管后壁损伤。
有经验的人员应采用环甲膜切开术的标准手术方法。无经验的人员可以使用Nu-Trake装置，该装置因便于操作而更快，但会导致更严重的并发症。我们建议定期在人体尸体、可能的动物模型或人体模型上练习环甲膜切开术，以便在高级气道管理方面得到充分训练。
