Department of Emergency Medicine, University of Fukui Hospital, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, 910-1193, Yoshida-gun, Fukui, Japan.
Department of General Medicine, University of Fukui Hospital, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, 910-1193, Yoshida-gun, Fukui, Japan.
BMC Emerg Med. 2023 Mar 16;23(1):29. doi: 10.1186/s12873-023-00796-9.
Accurate identification of the cricothyroid membrane is crucial for successful cricothyrotomy; however, a manoeuvre that helps identify it both accurately and quickly remains unclear. The effectiveness of the so-called 'bottom-up manoeuvre' has never been investigated. This study aimed to examine whether the bottom-up manoeuvre is as rapid and accurate as the conventional 'top-down manoeuvre' at identifying the cricothyroid membrane.
This study was a prospective randomised cross-over trial conducted at an academic medical centre between 2018 and 2019. Fifth-year medical students participated. The students were trained in the use of either the top-down manoeuvre or the bottom-up manoeuvre first. Each student subsequently performed the technique once on a volunteer. The students were then taught and practiced the other manoeuvre as well. The accuracy of cricothyroid membrane identification and the time taken by successful participants only were measured and compared between the manoeuvres using equivalence tests with two one-sided tests.
A total of 102 medical students participated in this study and there was no missing data. The accuracy of identification and time required for success were similar between the top-down manoeuvre and the bottom-up manoeuvre (65.7% vs. 70.6%, taking 13.8 s [interquartile range (IQR): 9.4-17.5] vs. 15.5 s [IQR: 11.5-19.9], respectively). The success rate was statistically equivalent (rate difference, 4.9%; 90% confidence interval [CI], -5.8 to 15.6; equivalence margin, -20.0 to 20.0). The time required for success was also statistically equivalent (median difference, 1.7 s; 90% CI, -0.2 to 3.3; equivalence margin, -4.0 to 4.0).
Among students first trained in both manoeuvres for identifying the cricothyroid membrane, the speed and accuracy of identification were similar between those using the bottom-up manoeuvre and those using the top-down manoeuvre.
准确识别甲状舌骨膜对于成功进行环甲膜切开术至关重要；然而，一种能够准确、快速识别甲状舌骨膜的操作方法仍不明确。所谓的“自下而上”操作的效果从未被研究过。本研究旨在检验“自下而上”操作在识别甲状舌骨膜方面是否与传统的“自上而下”操作一样快速、准确。
这是一项 2018 年至 2019 年在学术医学中心进行的前瞻性随机交叉试验，参与者为五年级医学生。学生首先接受自上而下或自下而上操作的培训。随后，每位学生对一名志愿者进行一次操作。然后，学生们还学习并练习了另一种操作。使用双侧单侧检验的等效检验，比较两种操作在识别甲状舌骨膜的准确性和成功所需的时间。
共有 102 名医学生参与了这项研究，没有缺失数据。自上而下操作和自下而上操作的识别准确率和成功所需时间相似（65.7%比 70.6%，分别需要 13.8 秒[四分位距（IQR）：9.4-17.5]和 15.5 秒[IQR：11.5-19.9]）。成功率在统计学上是等效的（差异率，4.9%；90%置信区间[CI]，-5.8 至 15.6；等效边界，-20.0 至 20.0）。成功所需的时间也在统计学上等效（中位数差异，1.7 秒；90%CI，-0.2 至 3.3；等效边界，-4.0 至 4.0）。
在接受过识别甲状舌骨膜的两种操作训练的学生中，使用自下而上操作和自上而下操作的识别速度和准确性相似。
