• Michelle Fischer Keane, Kathryn H Brinsfield, K Sophia Dyer, Simon Roy, and Daniel White.
• Boston Medical Center and Boston Emergency Medical Services, Boston, Massachusetts 02118-2525, USA. keane_m@bostonems.org
• Prehosp Emerg Care. 2004 Oct 1; 8 (4): 424-6.

ObjectiveTo compare the speeds and success rates of placement for percutaneous cricothyrotomy versus surgical or open cricothyrotomy.MethodsTwenty-two paramedics (mean 9.7 years of experience), with training in both methods, were timed using a pig trachea in a crossover model. An emergency physician performed timing and documentation of success; timing commenced after the equipment was ready and the membrane was identified. Paramedics were randomly assigned by a coin toss to start in either group. All were actively employed by a municipal third-service emergency medical services (EMS) agency. Paramedics who did not complete one of the methods correctly were excluded from speed analysis. Data were analyzed using descriptive statistics, a t-test of paired samples, and confidence intervals for matched samples.ResultsPlacement of a surgical cricothyrotomy was significantly faster (mean 28 seconds, range 10-78 seconds) than the percutaneous method (mean 123 seconds, range 58-257 seconds) (p < 0.001). Mean difference between the 20 matched percutaneous versus surgical pairs was 93.75 seconds (95% CI 72.3, 115.2). The surgical route had a 100% success rate at obtaining airway control, whereas the percutaneous method had a 90.9% success rate (p = 0.1).ConclusionIn an animal model, surgical cricothyrotomy appeared to be a preferable method for establishing a definitive airway over the percutaneous method. Further research is required to define the optimal approach in the prehospital setting for the invasive airway.

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