Cric-Guide – a review of an innovative scalpel designed for adult surgical cricothyroidotomy

Abstract

This is a review of the design, development and peer evaluation of Cric-Guide – an innovative scalpel device for emergency front of neck access in adults. The Cric-Guide is designed to replace the standard scalpel blade in the scalpel-bougie-tube technique and improve its success by guiding the bougie into the airway. The handle incorporates two depth guards which impact on the skin each side of the incision to limit insertion depth and reduce posterior damage to the airway.Five research evaluations of Cric-Guide during simulated cricothyroidotomy have been completed. Four compared the performance of Cric-Guide with the standard scalpel in the scalpel-bougie-tube technique, in manikins using porcine larynxes made more difficult with simulated obesity or bleeding or both. Cric-Guide had a lower failure rate on the first attempt particularly with the bleeding simulation and a lower false passage rate in the obese simulations. The other study evaluated Cric-Guide during cricothyroidotomy on intact human cadavers and was successful in all 12 cadavers on the first attempt with no false passages.The Cric-Guide performs surgical cricothyroidotomy effectively in human cadavers and porcine models and is presented as a possible alternative to the standard scalpel for emergency front of neck access.