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Development of a rapid, safe, fiber-optic guided, single-incision cricothyrotomy using a large ovine model: A pilot study

  • Lorenzo Paladino
    Affiliations
    Department of Emergency Medicine, SUNY Downstate Medical Center, 450 Clarkson Avenue, Box 1228, Brooklyn, NY 11203, United States
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  • James DuCanto
    Affiliations
    Department of Anesthesiology, Medical College of Wisconsin, 2900 West Oklahoma Avenue, Milwaukee, WI 53215, United States
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  • Author Footnotes
    1 Formerly at: Department of Anesthesiology, Medical College of Wisconsin, 2900 West Oklahoma Avenue, Milwaukee, WI 53215, United States.
    Seth Manoach
    Correspondence
    Corresponding author.
    Footnotes
    1 Formerly at: Department of Anesthesiology, Medical College of Wisconsin, 2900 West Oklahoma Avenue, Milwaukee, WI 53215, United States.
    Affiliations
    Department of Emergency Medicine, SUNY Downstate Medical Center, 450 Clarkson Avenue, Box 1228, Brooklyn, NY 11203, United States
    Search for articles by this author
  • Author Footnotes
    1 Formerly at: Department of Anesthesiology, Medical College of Wisconsin, 2900 West Oklahoma Avenue, Milwaukee, WI 53215, United States.

      Abstract

      Study aim

      We present a pilot study in which we use an ovine model to develop a rapid, safe cricothyrotomy technique using a Melker cuffed 5.0 cricothyrotomy catheter loaded over a fiberoptic stainless steel optical stylet. The technique requires a single incision. The stylet allows easy placement and facilitates visual, tactile, and transillumination confirmation of intratracheal placement. We recorded this process on video to facilitate the development of the procedure and to allow others to replicate it for further research or refinement. All devices used in this technique are currently employed in clinical practice.

      Methods

      We performed the procedure in four anesthetized sheep, varying the technique to maximize speed, demonstrate pitfalls, and optimize video recording of confirmation methods. We recorded each case using a 4-channel digital video recorder.

      Results

      After making a single scalpel incision we inserted the stylet and confirmed placement by visualization, transillumination, “click” palpation, and gentle stylet-driven tracheal displacement. We passed the cricothyrotomy tubes without difficulty and easily ventilated the animals.

      Conclusion

      The procedure is rapid, incorporates redundant safety features, and uses equipment increasingly available to anesthesiologists, emergency physicians, intensivists and surgeons. The promising outcome of this pilot study should be verified in a larger controlled, comparative trial.

      Keywords

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