Wong David T, Prabhu Atul J, Coloma Margarita, Imasogie Ngozi, Chung Frances F
Department of Anesthesiology, Toronto Western Hospital, University of Toronto, Ontario, Canada.
Anesthesiology. 2003 Feb;98(2):349-53. doi: 10.1097/00000542-200302000-00013.
A correctly performed cricothyroidotomy may be lifesaving in a cannot-ventilate, cannot-intubate situation. However, many practicing anesthesiologists do not have experience with cricothyroidotomy. The purpose of this study was to determine the minimum training required to perform cricothyroidotomy in 40 s or less in mannequins.
After informed consent, participants were shown a demonstration video and asked to perform 10 consecutive cricothyroidotomy procedures on a mannequin using a preassembled percutaneous dilational cricothyroidotomy set. Each attempt was timed from skin palpation to lung insufflation. Cricothyroidotomy was considered successful if it was performed in 40 s or less, and the cricothyroidotomy time was considered to have plateaued when there were no significant reductions in cricothyroidotomy times in three consecutive attempts.
One hundred two anesthesiologists participated in the study. There was a significant reduction of cricothyroidotomy times over the 10 attempts (P < 0.0001) and between three consecutive attempts until the fourth attempt (P < 0.03). The cricothyroidotomy times plateaued by the fourth attempt, while the success rate plateaued at the fifth attempt (94, 96, 96, and 96% at the fourth, fifth, sixth, and seventh attempts, respectively).
Practice on mannequins leads to reductions in cricothyroidotomy times and improvement in success rates. By the fifth attempt, 96% of participants were able to successfully perform the cricothyroidotomy in 40 s or less. While clinical correlates are not known, the authors recommend that providers of emergency airway management be trained on mannequins for at least five attempts or until their cricothyroidotomy time is 40 s or less. The most appropriate retraining intervals have yet to be determined for optimal cricothyroidotomy skill retention.
在无法通气、无法插管的情况下，正确实施环甲膜切开术可能挽救生命。然而，许多执业麻醉医师没有环甲膜切开术的经验。本研究的目的是确定在人体模型上在40秒或更短时间内实施环甲膜切开术所需的最低培训量。
在获得知情同意后，向参与者展示一段演示视频，并要求他们使用预组装的经皮扩张环甲膜切开术套件在人体模型上连续进行10次环甲膜切开术操作。每次尝试从皮肤触诊计时至肺通气。如果在40秒或更短时间内完成环甲膜切开术，则认为手术成功，当连续三次尝试中环甲膜切开术时间没有显著缩短时，则认为环甲膜切开术时间已趋于平稳。
102名麻醉医师参与了本研究。在10次尝试中，环甲膜切开术时间显著缩短（P<0.0001），在第四次尝试之前，连续三次尝试之间也有显著缩短（P<0.03）。环甲膜切开术时间在第四次尝试时趋于平稳，而成功率在第五次尝试时趋于平稳（第四次、第五次、第六次和第七次尝试的成功率分别为94%、96%、96%和96%）。
在人体模型上练习可缩短环甲膜切开术时间并提高成功率。到第五次尝试时，96%的参与者能够在40秒或更短时间内成功实施环甲膜切开术。虽然尚不清楚临床相关性，但作者建议急诊气道管理人员在人体模型上接受至少五次尝试的培训，或直至其环甲膜切开术时间为40秒或更短。对于最佳的环甲膜切开术技能保持，最合适的再培训间隔尚未确定。
