Research Paper Title

A randomized cross-over study comparing surgical cricothyrotomy techniques by combat medics using a synthetic cadaver model.

Background

Cricothyrotomy is a complex procedure with a high rate of complications including failure to cannulate and injury to adjacent anatomy. The Control-Cric™ System and QuickTrach II™ represent two novel devices designed to optimise success and minimize complications with this procedure. This study compares these two devices against a standard open surgical technique.

Methods

The researchers conducted a randomised crossover study of United States Army combat medics using a synthetic cadaver model. Participants performed a surgical cricothyrotomy using the standard open surgical technique, Control-Cric™ System, and QuickTrach II™ device in a random order. The primary outcome was time to successful cannulation. The secondary outcome was first-attempt success. They also surveyed participants after performing the procedures as to their preferences.

Results

Of 70 enrolled subjects, 65 completed all study procedures. Of those that successfully cannulated, the mean times to cannulation were comparable for all three methods:

• Standard 51.0s (95% CI 45.2-56.8);
• QuickTrach II™ 39.8s (95% CI 31.4-48.2); and
• The Cric-Control™ 53.6 (95% CI 45.7-61.4).

Cannulation failure rates were not significantly different:

• Standard 6.2%;
• QuickTrach II™ 13.9%; and
• Cric-Control™ 18.5% (p=0.106).

First pass success rates were also similar (93.4%, 91.1%, 88.7%, respectively, p=0.670). Of respondents completing the post-study survey, a majority (52.3%) preferred the QuickTrach II™ device.

Conclusions

The researchers identified no significant differences between the three cricothyrotomy techniques with regards to time to successful cannulation or first-pass success.

Reference

Schauer, S.G., Fernandez, J.R., Roper, J., Brown, D., Jeffers, K., Srichandra, J., Davids, N.B. & April, M.D. (2017) A randomized cross-over study comparing surgical cricothyrotomy techniques by combat medics using a synthetic cadaver model. The American Journal of Emergency Medicine. pii: S0735-6757(17)30972-5. doi: 10.1016/j.ajem.2017.11.062. [Epub ahead of print].