Safety and efficacy of the rapid four-step technique for cricothyrotomy using a Bair Claw

Abstract

The Rapid Four-Step Technique (RFST) has been demonstrated to be faster than standard open crico thyrotomy technique, but may have a higher incidence of cricoid injury with tracheal hook traction applied caudad. The “Bair Claw” is a novel device that may help eliminate these complications. This randomized, experimental trial used a fresh-frozen cadaver model of cricothyrotomy to compare speed and safety between RFST using a Bair Claw and standard open technique. Outcome measures included time to definitive airway, size of largest endotracheal (ET) tube able to be passed, and incidence of complications. We observed that RFST using a Bair Claw was significantly faster than standard open technique. There was no significant difference with regard to size of ET tube able to be passed with RFST using a Bair Claw versus standard open technique, and there was no damage to trachea or larynx observed with either technique. We concluded that RFST using a Bair Claw is faster and appears to be equally safe when compared to standard open technique in a fresh-frozen cadaver model of cricothyrotomy. The two techniques were equal with regard to maximal ET tube size.