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Acta Anaesthesiol Scand. 2019 Jul 9. doi: 10.1111/aas.13447. [Epub ahead of print]

Percutaneous versus surgical emergency cricothyroidotomy: An experimental randomised crossover study on an animal-larynx model.

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Department of Research, Norwegian Air Ambulance Foundation, NO-0184, Oslo, Norway.
Department of Anaesthesiology and Intensive Care, Vestre Viken Hospital Trust, NO-3004, Drammen, Norway.
Division of Prehospital Services, Institute of Clinical Medicine, University of Oslo, NO-0318, Oslo, Norway.
Norwegian National Advisory Unit on Prehospital Emergency Medicine, Oslo University Hospital, NO-0450, Oslo, Norway.
Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, Rikshospitalet, NO-0372, Norway.
Division of Emergencies and Critical Care, Institute of Clinical Medicine, University of Oslo, NO-1171, Oslo, Norway.
Norwegian National Advisory Unit on Trauma, Division of Emergencies and Critical Care, Oslo University Hospital, NO-0372, Oslo, Norway.



Airway management is a paramount clinical skill for the anaesthesiologist. The Emergency Cricothyroidotomy (EC) constitutes the final step in difficult airway algorithms securing a patent airway via a front-of-neck access. The main distinction among available techniques is whether the procedure is surgical and scalpel-based or percutaneous and needle-based.


In an experimental randomised crossover trial, using an animal larynx model, we compared two EC techniques; the Rapid Four Step Technique and the Melker Emergency Cricothyrotomy Kit®. We assessed time expenditure and success rates among twenty anaesthesiologists and related this to previous training, seniority, and clinical experience with Emergency Cricothyroidotomy(EC).


All participants achieved successful airway access with both methods. Average time to successful airway access for scalpel-based EC was 54 (± 31) seconds and for percutaneous EC 89 (± 38) seconds, with 35 (95% CI: 14-57) seconds time difference, p = 0.003. Doctors with recent (<12 months) EC training performed better compared to the non-training group (37 vs. 61 seconds, p = 0.03 for scalpel-based EC, and 65 vs. 99 seconds, p = 0.02 for percutaneous EC). We found no differences according to clinical seniority or previous real-life EC experience.


Our study demonstrated that anaesthesiologists achieved successful airway access on an animal experimental model with both EC methods within a reasonable time frame, but the scalpel-based EC is performed more promptly. Recent EC training affected the time expenditure positively, while seniority and clinical EC experience did not. EC procedures should be regularly trained for. This article is protected by copyright. All rights reserved.


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