A comparison of three techniques for cricothyrotomy on a manikin.
Bibliographic record
Abstract
BACKGROUND: Cricothyrotomy can either be performed by an "open" cricothyrotomy technique, or by a needle (Seldinger) technique. Clinical uncertainty exists regarding which technique is more effective. We compared three different techniques for cricothyrotomy, performed by anesthesiologists on a manikin. METHODS: The techniques studied include an open surgical technique, the Melker Cricothyrotomy kit (Cook), and the Portex Cricothyroidotomy Kit (Smiths Medical). Participants were randomized to the order they performed each technique. Each procedure was videotaped and the time to first ventilation recorded. The participants completed a 10-point scale following the performance of all techniques to assess the subjective level of difficulty of each technique and to indicate which technique they would prefer in a real clinical CICO scenario. RESULTS: Mean time to ventilation was significantly faster with the surgical cricothyrotomy technique, when compared with both the Portex and Melker techniques (Mean difference: Portex-surgical = 18 s, 95% CI (1, 36) and Melker-surgical = 42 s, 95% CI (31, 54)). The Portex technique was significantly faster than the Melker technique (Melker-Portex = 24 s, 95% CI (11, 37)). Six of the 11 (55%) participants preferred the Melker procedure, four (36%) preferred the surgical procedure, and only one anesthesiologist (9%) preferred the Portex procedure. DISCUSSION: The surgical technique was faster than both the Portex and Melker techniques. The surgical technique was also more successful than the Melker technique. The preferred technique among the participants was the Melker technique, despite being the slowest, least successful, and rated most difficult by participants and observers. This suggests that although the surgical technique may not be preferred by many airway practitioners, it has been shown to be the most likely technique to achieve the primary goal of the procedure: establishing oxygenation and preventing death. IMPLICATION STATEMENT: This research examines three techniques for cricothyrotomy in the "Can't Intubate, Can't Oxygenate" scenario. Our data, as well as data from other studies, suggest that a practice shift towards a surgical technique, and away from needle based techniques, may be warranted.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.021 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".