In our study, cricothyroidotomy performed with the NT was faster than with the ST. A mean duration of 49 s was reported for the NT in an unpublished study in 10 cadavers (A Patel: Evaluation of a New Emergency Cricothyroidotomy Device in 10 Cadavers. Difficult Airway Society annual Scientific Meeting. 2004). When comparing the ST and the “surgical approach” (related to the NT because the PCK is inserted through an incision with a surgical blade), the ST lasted longer due to the required introduction of a guidewire before insertion of the cannula.12
Previous studies comparing other devices have used plastic manikins, animals, various kinds of embalmed cadavers, and live patients. Depending on the model, the success rate of the cricothyroidotomy varies. Johnson et al.13 reported an 86% success rate for cricothyroidotomy by “surgical approach” and a 73% rate with percutaneous devices. A 100% success rate with the standard Melker kit was reported in plastic manikins,14 whereas a similar high success rate of 92% was observed with the cuffed Melker device.15 On fresh cadavers, Eisenburger et al.12 had a lower (60%) success rate using ST, but Schaumann et al.16 reported an 88% rate in 200 cadavers. Our study recorded a success rate of 95%. Tissue elasticity and neck rigidity of the cadavers and the experience of the operators may be among the many possible explanations for such differences. Concerning the new device, no consistent data are available in the literature, and we found a nonsignificantly lower success rate of 80%. This global success rate could be considered acceptable when compared with the global success rate of the Seldinger device. The 5-min duration limit was chosen arbitrarily, considering the fact that such a technique should be performed rapidly to avoid prolonged apnea.
Both the number and the severity of the lesions observed were lower with the ST than with the NT. There are various reasons for this finding. First, the ST does not require any contact between the needle and the posterior wall of the larynx. In the NT, this contact is recommended, and turned out to be responsible for the lesions we encountered. Second, the guidewire may avoid a possible dissection of the posterior wall of the trachea, whereas in the NT there is no way to confirm the correct position of the device. Third, the curved form of the Melker directs the device preferentially in the caudal direction and avoids any contact with the posterior wall of the trachea, whereas the rectilinear and rigid PCK does not. In our experience, the smaller diameter of the cuffed Melker device makes it easier to insert than the PCK. In anesthetized dogs, Abbrecht et al.17 established a linear correlation between insertion force and device diameter, and the incidence of complications.
In a human cadaver model, despite requiring a shorter time to achieve the cricothyroidotomy, the NT using mechanic detection of the posterior wall of the larynx was responsible for more lesions and more failures than the standard set in which cricothyroidotomy was based on the ST.
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