A Randomized Trial Comparing Two Cuffed Emergency Cricothyrotomy Devices Using a Wire-Guided and a Catheter-Over-Needle Technique

Abstract Background: According to different algorithms of airway management, emergency cricothyrotomy is the final step in managing the otherwise inaccessible airway. As an alternative to an open surgical procedure, minimally invasive approaches exist. Various sets for different methods are commerci...

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Veröffentlicht in:The Journal of emergency medicine 2011-09, Vol.41 (3), p.326-332
Hauptverfasser: Metterlein, Thomas, MD, Frommer, Matthias, MD, Ginzkey, Christian, MD, Becher, Jan, MD, Schuster, Frank, MD, Roewer, Norbert, MD, Kranke, Peter, MD
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container_end_page 332
container_issue 3
container_start_page 326
container_title The Journal of emergency medicine
container_volume 41
creator Metterlein, Thomas, MD
Frommer, Matthias, MD
Ginzkey, Christian, MD
Becher, Jan, MD
Schuster, Frank, MD
Roewer, Norbert, MD
Kranke, Peter, MD
description Abstract Background: According to different algorithms of airway management, emergency cricothyrotomy is the final step in managing the otherwise inaccessible airway. As an alternative to an open surgical procedure, minimally invasive approaches exist. Various sets for different methods are commercially available. QuickTrach™ (VBM Medizintechnik GmbH, Sulz am Neckar, Germany) contains a plastic cannula over a metal needle for direct placement in the trachea, whereas a guide-wire is used for the actual placement of the cannula in the Melker Set™ (Cook Group Incorporated, Bloomington, IN). Objective: We hypothesize that the direct puncture involving less discrete steps is faster to perform. However, it will lead to more complications due to the higher force needed to place the relatively thick needle. Method: After approval of the local ethics committee, the study was performed on cadavers of 16 adult sheep. A wire-guided cricothyrotomy was compared with a catheter-over-needle technique. Successful placement and performance time were compared. Complication rate and maximal achieved airway pressure were evaluated. Data is given as mean and interquartile range, and Mann-Whitney U-test ( p < 0.05) for significant differences. Results: With the wire-guided technique, successful placement was possible in all attempts. The catheter-over-needle method was successful in 63% and had a higher complication rate (75% vs. 13%). The cannula-over-needle method allowed a faster cricothyrotomy (32 [2–34] vs. 53 [52–56] s). Both methods allowed the delivery of similar maximal airway pressures (50 [44–51] vs. 48 [43–53] mbar). Conclusion: The wire-guided method proved to be the more reliable technique, leading to fewer complications. However, the direct puncture was faster to perform. Placed accurately, both devices allowed sufficient ventilation.
doi_str_mv 10.1016/j.jemermed.2010.04.008
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As an alternative to an open surgical procedure, minimally invasive approaches exist. Various sets for different methods are commercially available. QuickTrach™ (VBM Medizintechnik GmbH, Sulz am Neckar, Germany) contains a plastic cannula over a metal needle for direct placement in the trachea, whereas a guide-wire is used for the actual placement of the cannula in the Melker Set™ (Cook Group Incorporated, Bloomington, IN). Objective: We hypothesize that the direct puncture involving less discrete steps is faster to perform. However, it will lead to more complications due to the higher force needed to place the relatively thick needle. Method: After approval of the local ethics committee, the study was performed on cadavers of 16 adult sheep. A wire-guided cricothyrotomy was compared with a catheter-over-needle technique. Successful placement and performance time were compared. Complication rate and maximal achieved airway pressure were evaluated. Data is given as mean and interquartile range, and Mann-Whitney U-test ( p &lt; 0.05) for significant differences. Results: With the wire-guided technique, successful placement was possible in all attempts. The catheter-over-needle method was successful in 63% and had a higher complication rate (75% vs. 13%). The cannula-over-needle method allowed a faster cricothyrotomy (32 [2–34] vs. 53 [52–56] s). Both methods allowed the delivery of similar maximal airway pressures (50 [44–51] vs. 48 [43–53] mbar). Conclusion: The wire-guided method proved to be the more reliable technique, leading to fewer complications. However, the direct puncture was faster to perform. Placed accurately, both devices allowed sufficient ventilation.</description><identifier>ISSN: 0736-4679</identifier><identifier>EISSN: 2352-5029</identifier><identifier>DOI: 10.1016/j.jemermed.2010.04.008</identifier><identifier>PMID: 20605389</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Animals ; Cadaver ; Cricoid Cartilage - surgery ; cricothyrotomy ; Emergency ; emergency airway management ; Emergency Medicine - methods ; Melker Set ; QuickTrach ; Random Allocation ; Sheep ; Thyroid Cartilage - surgery ; tracheotomy ; Tracheotomy - instrumentation ; Tracheotomy - methods</subject><ispartof>The Journal of emergency medicine, 2011-09, Vol.41 (3), p.326-332</ispartof><rights>Elsevier Inc.</rights><rights>2011 Elsevier Inc.</rights><rights>Copyright © 2011 Elsevier Inc. 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As an alternative to an open surgical procedure, minimally invasive approaches exist. Various sets for different methods are commercially available. QuickTrach™ (VBM Medizintechnik GmbH, Sulz am Neckar, Germany) contains a plastic cannula over a metal needle for direct placement in the trachea, whereas a guide-wire is used for the actual placement of the cannula in the Melker Set™ (Cook Group Incorporated, Bloomington, IN). Objective: We hypothesize that the direct puncture involving less discrete steps is faster to perform. However, it will lead to more complications due to the higher force needed to place the relatively thick needle. Method: After approval of the local ethics committee, the study was performed on cadavers of 16 adult sheep. A wire-guided cricothyrotomy was compared with a catheter-over-needle technique. Successful placement and performance time were compared. Complication rate and maximal achieved airway pressure were evaluated. Data is given as mean and interquartile range, and Mann-Whitney U-test ( p &lt; 0.05) for significant differences. Results: With the wire-guided technique, successful placement was possible in all attempts. The catheter-over-needle method was successful in 63% and had a higher complication rate (75% vs. 13%). The cannula-over-needle method allowed a faster cricothyrotomy (32 [2–34] vs. 53 [52–56] s). Both methods allowed the delivery of similar maximal airway pressures (50 [44–51] vs. 48 [43–53] mbar). Conclusion: The wire-guided method proved to be the more reliable technique, leading to fewer complications. However, the direct puncture was faster to perform. Placed accurately, both devices allowed sufficient ventilation.</description><subject>Animals</subject><subject>Cadaver</subject><subject>Cricoid Cartilage - surgery</subject><subject>cricothyrotomy</subject><subject>Emergency</subject><subject>emergency airway management</subject><subject>Emergency Medicine - methods</subject><subject>Melker Set</subject><subject>QuickTrach</subject><subject>Random Allocation</subject><subject>Sheep</subject><subject>Thyroid Cartilage - surgery</subject><subject>tracheotomy</subject><subject>Tracheotomy - instrumentation</subject><subject>Tracheotomy - methods</subject><issn>0736-4679</issn><issn>2352-5029</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkkFv1DAQhS0EokvhL1S-ccoythMnuSCqtLRIFZVgK46W40y6XpJ4sZNF4cY_r6PtXrhwsaWZ9-ZpPg0hFwzWDJj8sFvvsEffY7PmEIuQrgGKF2TFRcaTDHj5kqwgFzJJZV6ekTch7ABYDgV7Tc44SMhEUa7I30v6TQ-N6-0fbOjGW93RyvV77e3wSDe_Ha2mto2t65j2iIOZaeWtceN29m50_Uyv8GANBvoQFoemP6zH5GayTTTFybFS6XGLI_rk_hCfr4hNh3SDZjvYXxO-Ja9a3QV89_yfk4fP15vqNrm7v_lSXd4lJuV8THKZ5q1EwcDUQvC0zDXouITIc86y2GmZAMPqmmdMl6JErGVbZ9g0UmJmGnFO3h_n7r2LsWFUvQ0Gu04P6KagiqJMsziKRaU8Ko13IXhs1d7bXvtZMVALfbVTJ_pqoa8gVZF-NF48R0z10jvZTrij4NNRgHHRg0WvgrERKjYRmhlV4-z_Mz7-M8J0drBGdz9xxrBzkx8iRsVU4ArU9-UGlhNgAMAlY-IJwGqu-g</recordid><startdate>20110901</startdate><enddate>20110901</enddate><creator>Metterlein, Thomas, MD</creator><creator>Frommer, Matthias, MD</creator><creator>Ginzkey, Christian, MD</creator><creator>Becher, Jan, MD</creator><creator>Schuster, Frank, MD</creator><creator>Roewer, Norbert, MD</creator><creator>Kranke, Peter, MD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20110901</creationdate><title>A Randomized Trial Comparing Two Cuffed Emergency Cricothyrotomy Devices Using a Wire-Guided and a Catheter-Over-Needle Technique</title><author>Metterlein, Thomas, MD ; Frommer, Matthias, MD ; Ginzkey, Christian, MD ; Becher, Jan, MD ; Schuster, Frank, MD ; Roewer, Norbert, MD ; Kranke, Peter, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c422t-7647f6e310cb332497a0a053377215f6ef130c1bb251a939eeb6fb5edd66e5cd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Animals</topic><topic>Cadaver</topic><topic>Cricoid Cartilage - surgery</topic><topic>cricothyrotomy</topic><topic>Emergency</topic><topic>emergency airway management</topic><topic>Emergency Medicine - methods</topic><topic>Melker Set</topic><topic>QuickTrach</topic><topic>Random Allocation</topic><topic>Sheep</topic><topic>Thyroid Cartilage - surgery</topic><topic>tracheotomy</topic><topic>Tracheotomy - instrumentation</topic><topic>Tracheotomy - methods</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Metterlein, Thomas, MD</creatorcontrib><creatorcontrib>Frommer, Matthias, MD</creatorcontrib><creatorcontrib>Ginzkey, Christian, MD</creatorcontrib><creatorcontrib>Becher, Jan, MD</creatorcontrib><creatorcontrib>Schuster, Frank, MD</creatorcontrib><creatorcontrib>Roewer, Norbert, MD</creatorcontrib><creatorcontrib>Kranke, Peter, MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of emergency medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Metterlein, Thomas, MD</au><au>Frommer, Matthias, MD</au><au>Ginzkey, Christian, MD</au><au>Becher, Jan, MD</au><au>Schuster, Frank, MD</au><au>Roewer, Norbert, MD</au><au>Kranke, Peter, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A Randomized Trial Comparing Two Cuffed Emergency Cricothyrotomy Devices Using a Wire-Guided and a Catheter-Over-Needle Technique</atitle><jtitle>The Journal of emergency medicine</jtitle><addtitle>J Emerg Med</addtitle><date>2011-09-01</date><risdate>2011</risdate><volume>41</volume><issue>3</issue><spage>326</spage><epage>332</epage><pages>326-332</pages><issn>0736-4679</issn><eissn>2352-5029</eissn><abstract>Abstract Background: According to different algorithms of airway management, emergency cricothyrotomy is the final step in managing the otherwise inaccessible airway. As an alternative to an open surgical procedure, minimally invasive approaches exist. Various sets for different methods are commercially available. QuickTrach™ (VBM Medizintechnik GmbH, Sulz am Neckar, Germany) contains a plastic cannula over a metal needle for direct placement in the trachea, whereas a guide-wire is used for the actual placement of the cannula in the Melker Set™ (Cook Group Incorporated, Bloomington, IN). Objective: We hypothesize that the direct puncture involving less discrete steps is faster to perform. However, it will lead to more complications due to the higher force needed to place the relatively thick needle. Method: After approval of the local ethics committee, the study was performed on cadavers of 16 adult sheep. A wire-guided cricothyrotomy was compared with a catheter-over-needle technique. Successful placement and performance time were compared. Complication rate and maximal achieved airway pressure were evaluated. Data is given as mean and interquartile range, and Mann-Whitney U-test ( p &lt; 0.05) for significant differences. Results: With the wire-guided technique, successful placement was possible in all attempts. The catheter-over-needle method was successful in 63% and had a higher complication rate (75% vs. 13%). The cannula-over-needle method allowed a faster cricothyrotomy (32 [2–34] vs. 53 [52–56] s). Both methods allowed the delivery of similar maximal airway pressures (50 [44–51] vs. 48 [43–53] mbar). Conclusion: The wire-guided method proved to be the more reliable technique, leading to fewer complications. However, the direct puncture was faster to perform. Placed accurately, both devices allowed sufficient ventilation.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>20605389</pmid><doi>10.1016/j.jemermed.2010.04.008</doi><tpages>7</tpages></addata></record>
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source MEDLINE; Access via ScienceDirect (Elsevier)
subjects Animals
Cadaver
Cricoid Cartilage - surgery
cricothyrotomy
Emergency
emergency airway management
Emergency Medicine - methods
Melker Set
QuickTrach
Random Allocation
Sheep
Thyroid Cartilage - surgery
tracheotomy
Tracheotomy - instrumentation
Tracheotomy - methods
title A Randomized Trial Comparing Two Cuffed Emergency Cricothyrotomy Devices Using a Wire-Guided and a Catheter-Over-Needle Technique
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