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Effect of palpable vs. impalpable cricothyroid membranes in a simulated emergency front‐of‐neck access scenario
Author(s) -
Pairaudeau C. F.,
Mendonca C.,
Hillermann C.,
Qazi I.,
Baker P. A.,
Hodgson R. E.,
Radhakrishna S.
Publication year - 2018
Publication title -
anaesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.839
H-Index - 117
eISSN - 1365-2044
pISSN - 0003-2409
DOI - 10.1111/anae.14218
Subject(s) - medicine , airway , cricothyrotomy , otorhinolaryngology , tracheal tube , airway management , surgery
Summary The Difficult Airway Society 2015 guidelines recommend and describe in detail a surgical cricothyroidotomy technique for the can't intubate, can't oxygenate ( CICO ) scenario, but this can be technically challenging for anaesthetists with no surgical training. Following a structured training session, 104 anaesthetists took part individually in a simulated can't intubate, can't oxygenate event using simulation and airway models to evaluate how well they could perform these front‐of‐neck access techniques. Main outcomes measures were: ability to correctly perform the technical steps; procedural time; and success rate. Outcomes were compared between palpable and impalpable cricothyroid membrane scenarios. Anaesthetists’ technical abilities were good, as assessed by a video analysis checklist score. Mean ( SD ) procedural time was 44 (16) s and 65 (17) s for the palpable and impalpable cricothyroid membrane models, respectively (p ≤ 0.001). First‐pass tracheal tube placement was obtained in 103 out of the 104 palpable cricothyroidotomies and in 101 out of the 104 impalpable cricothyroidotomies (p = 0.31). We conclude that anaesthetists can be trained to perform surgical front‐of‐neck access to an acceptable level of competence and speed when assessed using a simulator.