Ultrasound improves percutaneous needle cricothyrotomy success in the novice anesthesia provider compared to the landmark technique

Abstract

IntroductionThis study tested ultrasound guidance on the success of student registered nurse anesthetists’ performance of ultrasound guided percutaneous needle cricothyrotomy versus the superficial landmark approach. MethodsUsing a quasi-experimental crossover design, students were randomized to two groups to determine order of procedural performance: (1) superficial landmark, and (2) ultrasound guided percutaneous needle cricothyrotomy. All students completed both conditions at different time points. Performance was measured using a task-specific checklist survey tool and a global rating scale. Time to successful guidewire passage and number of attempts were measured along with accuracy. ResultsThe median scores for respect for tissue, time and motion, and use of assistant categories were significantly lower when using landmark-guidance compared to ultrasound-guidance to perform the procedure (P = .021; P = .042; P = .049). Using ultrasound guidance for the percutaneous needle cricothyrotomy resulted in significantly fewer number of attempts for cricothyroidotomy access (P < .001). Post survey data indicated overall, 87.6% (CI 95%: 7.86–9.31) of the students felt the use of ultrasound improved their experience and was a valuable tool in teaching percutaneous needle cricothyroidotomy (95.9%; CI95%: 8.56–9.77). Following the simulated experience, students felt more confident when performing the percutaneous needle cricothyrotomy procedure (87.4%; CI95%: 1.44–3.40). ConclusionsThe use of ultrasound guidance during percutaneous needle cricothyrotomy showed a decrease in the number of attempts by student nurse anesthetists’ when performing cricothyrotomy. Students found ultrasound guidance enhanced the ease, speed, confidence levels, and overall experience.