Department of Anaesthesiology, Johannes-Gutenberg Universität Mainz, Mainz, Rhineland-Palatinate, Germany.
Department of Anaesthesiology and Critical Care Medicine, Central hospital of the German armed forces, Koblenz, Rhineland-Palatinate, Germany.
PeerJ. 2024 Aug 23;12:e17788. doi: 10.7717/peerj.17788. eCollection 2024.
Performing an emergency cricothyroidotomy (EC) is extremely challenging, the devices used should be easy to handle and the selected technique reliable. However, there is still an ongoing debate concerning the most superior technique.
Three different techniques were compared using a standardized, simulated scenario regarding handling, performing, training and decision making: The scalpel-bougie technique (SBT), the surgical anatomical preparation technique (SAPT) and the Seldinger technique (ST). First, anaesthesia residents and trainees, paramedics and medical students (each group = 50) performed a cricothyroidotomy randomly assigned with each of the three devices on a simulator manikin. The time needed for successful cricothyroidotomy was the primary endpoint. Secondary endpoints included first-attempt success rate, number of attempts and user-satisfaction. The second part of the study investigated the impact of prior hands-on training on both material selection for EC and on time to decision-making in a simulated "cannot intubate cannot ventilate" situation.
The simulated scenario revealed that SBT and SAPT were significantly faster than percutaneous EC with ST ( < 0.0001). Success rate was 100% for the first attempt with SBT and SAPT. Significant differences were found with regard to user-satisfaction between individual techniques ( < 0.0001). In terms of user-friendliness, SBT was predominantly assessed as easy (87%). Prior training had a large impact regarding choice of devises ( < 0.05), and time to decision making ( = 0.05; 180 s . 233 s).
This study supports the use of a surgical technique for EC and also a regular training to create familiarity with the materials and the process itself.The trial was registered before study start on 11.11.2018 at (NCT: 2018-13819) with Nicole Didion as the principal investigator.
进行紧急环甲切开术（EC）极具挑战性，所用器械应易于操作，所选技术应可靠。然而，关于最优越的技术仍存在争议。
使用标准化模拟场景比较了三种不同的技术，包括操作、执行、培训和决策：手术刀-气管扩张器技术（SBT）、手术解剖准备技术（SAPT）和 Seldinger 技术（ST）。首先，麻醉住院医师和受训人员、护理人员和医学生（每组 50 人）在模拟人模型上随机使用三种设备中的每一种进行环甲切开术。成功完成环甲切开术所需的时间是主要终点。次要终点包括首次尝试成功率、尝试次数和用户满意度。研究的第二部分调查了之前动手培训对 EC 器械选择和模拟“无法插管-无法通气”情况下决策时间的影响。
模拟场景显示，SBT 和 SAPT 明显快于经皮 EC 与 ST（ < 0.0001）。SBT 和 SAPT 的首次尝试成功率为 100%。在用户满意度方面，不同技术之间存在显著差异（ < 0.0001）。在易用性方面，SBT 主要被评估为容易（87%）。之前的培训对器械选择（ < 0.05）和决策时间（ = 0.05；180 秒. 233 秒）有较大影响。
本研究支持使用手术技术进行 EC，并定期培训以熟悉材料和过程本身。该试验于 2018 年 11 月 11 日在开始研究前（NCT：2018-13819）进行了注册，Nicole Didion 是主要研究者。
