{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T14:25:23Z","timestamp":1761920723680},"reference-count":17,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","license":[{"start":{"date-parts":[[2020,2,1]],"date-time":"2020-02-01T00:00:00Z","timestamp":1580515200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>Cricothyroidotomy is the final strategy in the \u201ccannot intubate, cannot oxygenate\u201d scenario, but half of needle cricothyroidotomy attempts result in failure. The most frequent complication in needle cricothyroidotomy is posterior tracheal wall injury. We hypothesized that needle length is related to posterior wall injury and compared needle cricothyroidotomy with a commercial kit to a modified shorter needle to evaluate success and posterior wall injury rates.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>The commercial kit has a needle stopper to prevent posterior wall injury, with a penetrating length of 25\u200amm. We made long stopper to shorten the length by 5\u200amm (net 20\u200amm penetrating length). Residents were recruited, received a lecture about cricothyroidotomy and practiced needle cricothyroidotomy using the commercial kit on a simulator. They then performed cricothyroidotomy using the commercial kit or the shorter needle on an <jats:italic toggle=\"yes\">ex-vivo<\/jats:italic> porcine larynx covered with artificial skin. An intra-tracheal endoscope recorded the procedure. The video was evaluated for success\/failure or posterior wall injury by independent evaluators. Larynxes with a distance from the outer surface to the inner lumen exceeding 13\u200amm were excluded. The distance in each larynx was measured by dissection after the study. Success and posterior wall injury rates were analyzed using Fisher exact test (<jats:italic toggle=\"yes\">P<\/jats:italic>\u200a&lt;\u200a.05 was statistically significant).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>Forty-seven residents participated in the study. Data for two residents were excluded. There was no statistically significant difference in success rate between the commercial kit (100%, 45\/45) and the shorter needle (91%, 41\/45, <jats:italic toggle=\"yes\">P<\/jats:italic>\u200a=\u200a.12). Failure was defined if the needle tip did not reach the lumen in four trials. Cannulated but complicated by posterior wall injury occurred in 33% (15\/45) with the commercial kit and 5% (2\/43) with the shorter needle (<jats:italic toggle=\"yes\">P<\/jats:italic>\u200a&lt;\u200a.01).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion:<\/jats:title>\n            <jats:p>During needle cricothyroidotomy, force is needed for the needle to penetrate the cricothyroid ligament. The advancing needle sometimes cannot be stopped after penetrating the cricothyroid ligament. These data suggest that needle length is associated with posterior wall injury.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/md.0000000000019331","type":"journal-article","created":{"date-parts":[[2020,3,2]],"date-time":"2020-03-02T03:04:43Z","timestamp":1583118283000},"page":"e19331","source":"Crossref","is-referenced-by-count":4,"title":["Cricothyroidotomy needle length is associated with posterior tracheal wall injury"],"prefix":"10.1097","volume":"99","author":[{"given":"Atsuko","family":"Katayama","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Kyorin University School of Medicine, Sinkawa, Mitaka, Tokyo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kunitaro","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Kyorin University School of Medicine, Sinkawa, Mitaka, Tokyo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joho","family":"Tokumine","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Kyorin University School of Medicine, Sinkawa, Mitaka, Tokyo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alan Kawarai","family":"Lefor","sequence":"additional","affiliation":[{"name":"Department of Surgery, Jichi Medical University, Tochigi-ken, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harumasa","family":"Nakazawa","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Kyorin University School of Medicine, Sinkawa, Mitaka, Tokyo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ippei","family":"Jimbo","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Kyorin University School of Medicine, Sinkawa, Mitaka, Tokyo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomoko","family":"Yorozu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Kyorin University School of Medicine, Sinkawa, Mitaka, Tokyo"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","published-online":{"date-parts":[[2020,2]]},"reference":[{"key":"R1-20230915","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1097\/ALN.0b013e31827773b2","article-title":"Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway","volume":"118","author":"Apfelbaum","year":"2013","journal-title":"Anesthesiology"},{"key":"R2-20230915","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1093\/bja\/aev371","article-title":"Difficult Airway Society intubation guidelines working g: Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults","volume":"115","author":"Frerk","year":"2015","journal-title":"Br J Anaesth"},{"key":"R3-20230915","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1093\/bja\/aer059","article-title":"Fourth National Audit Project. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 2: intensive care and emergency departments","volume":"5","author":"Cook","year":"2011","journal-title":"Br J Anaesth"},{"key":"R4-20230915","doi-asserted-by":"crossref","first-page":"e14665","DOI":"10.1097\/MD.0000000000014665","article-title":"A high-fidelity simulator for needle cricothyroidotomy training is not associated with increased proficiency compared with conventional simulators: A randomized controlled study","volume":"98","author":"Katayama","year":"2019","journal-title":"Medicine (Baltimore)"},{"issue":"(Suppl 1)","key":"R6-20230915","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1055\/s-2007-1001106","article-title":"Cricothyreotomy using the Quicktrach coniotomy instrument set","volume":"25","author":"Frei","year":"1990","journal-title":"Anasth Intensivther Notfallmed"},{"key":"R7-20230915","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1016\/j.jsurg.2014.12.012","article-title":"Every surgical resident should know how to perform a cricothyrotomy: an inexpensive cricothyrotomy task trainer for teaching and assessing surgical trainees","volume":"72","author":"Aho","year":"2015","journal-title":"J Surg Educ"},{"key":"R8-20230915","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1007\/s12630-014-0183-0","article-title":"A survey of Canadian anesthesiologists\u2019 preferences in difficult intubation and \u201ccannot intubate, cannot ventilate\u201d situations","volume":"61","author":"Wong","year":"2014","journal-title":"Can J Anaesth"},{"key":"R9-20230915","doi-asserted-by":"crossref","first-page":"E1061","DOI":"10.1111\/j.1553-2712.2012.01436.x","article-title":"Emergency cricothyroidotomy: a randomized crossover trial comparing percutaneous techniques: classic needle first versus \u201cincision first\u201d","volume":"19","author":"Kanji","year":"2012","journal-title":"Acad Emerg 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Anat"},{"key":"R14-20230915","doi-asserted-by":"crossref","first-page":"515","DOI":"10.3109\/10903127.2010.497903","article-title":"A meta-analysis of prehospital airway control techniques part II: alternative airway devices and cricothyrotomy success rates","volume":"14","author":"Hubble","year":"2010","journal-title":"Prehosp Emerg Care"},{"key":"R15-20230915","doi-asserted-by":"crossref","first-page":"1153","DOI":"10.1111\/anae.14706","article-title":"Time to oxygenation for cannula- and scalpel-based techniques for emergency front-of-neck access: a wet lab simulation using an ovine model","volume":"74","author":"Rees","year":"2019","journal-title":"Anaesthesia"},{"key":"R16-20230915","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.1111\/acem.13037","article-title":"Evidence is important: safety considerations for emergency catheter cricothyroidotomy","volume":"23","author":"Marshall","year":"2016","journal-title":"Acad Emerg 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Anaesth"}],"container-title":["Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/MD.0000000000019331","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,16]],"date-time":"2023-09-16T00:01:54Z","timestamp":1694822514000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/MD.0000000000019331"}},"subtitle":["A randomized crossover simulation study (CONSORT)"],"short-title":[],"issued":{"date-parts":[[2020,2]]},"references-count":17,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2020]]}},"URL":"https:\/\/doi.org\/10.1097\/md.0000000000019331","relation":{},"ISSN":["0025-7974","1536-5964"],"issn-type":[{"value":"0025-7974","type":"print"},{"value":"1536-5964","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,2]]}}}