***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Emergency physicians and registrars performed emergency cricothyroidotomy on an artificial airway model using a st and ard surgical approach and three common commercial products , participants had received no refresher training . The order in which the methods were used was r and omised to minimise any learning effect . Three methods ( st and ard surgical , Minitrach II , and Quicktrach ) were universally successful in obtaining ventilation within 150 s , whilst the Melker kit had a 26 % failure rate and significantly longer median time to ventilation ( 126 s vs≤48 s for other methods , p < 0.001 ) . Despite success in using the surgical method , the Quicktrach and Minitrach II were rated as first or second preference by the majority of operators ( 78 % and 70 % respectively ) . Without refresher training emergency physicians and registrars successfully performed  emergency cricothyroidotomy using the st and ard surgical method , Quicktrach and Minitrach II kits however the use of the Melker kit under these conditions result ed in significant delays or failure to establish an airway Background To improve the ease and safety of cricothyroidotomy especially in the h and of the inexperienced , new instruments have been developed . In this study , we compared a new indicator-guided puncture technique ( PCK ) with st and ard surgical technique ( ST ) regarding success rate , performance time and complications . Methods  Cricothyroidotomy in 30 human cadavers performed by 30 first year anaesthesia residents . The set chosen for use was r and omised : PCK-technique ( n=15 ) and ST ( n=15 ) . Success rates , insertion times and complications were compared . Traumatic lesions were anatomically confirmed after dissection . Results The ST-group had a higher success rate ( 100 % vs 67 % ; p=0.04 ) . There was no difference in time taken to complete the procedure  ( PCK 82 s. vs ST 95 s. ; p=0.89 ) . There was a higher complication rate in the PCK-group ( 67 % vs 13 % ; p=0.04 ) . Most frequent complication in the PCK-group was injury to the posterior tracheal wall ( n=8 ) , penetration to the oesophageal lumen ( n=4 ) and injury to the thyroid and /or cricoid cartilage ( n=5 ) . In the ST-group in only 2 cases minor complications were observed ( small vessel injury ) . Conclusions In this human cadaver study the PCK technique produced more major complications and more failures than the ST . In the h and of the inexperienced operator the st and ard surgical approach seems to be a safe procedure , which can successfully be performed within an adequate time . The PCK technique can not be recommended for inexperienced operators BACKGROUND Emergency cricothyroidotomy is a potentially life-saving procedure in the ' can not intubate can not ventilate ( CICV ) ' scenario . Although surgical cricothyroidotomy remains the technique recommended in many ' CICV ' algorithms , the insertion of a tracheostomy as a cannula over a trocar , or using the Seldinger method , may have advantages as they are more familiar to the anaesthetist . We compared the utility of three cuffed cricothyroidotomy devices : cuffed Melker ® , Quicktrach 2 ® , and PCK ® devices , with surgical cricothyroidotomy . METHODS After ethical committee approval and written informed consent , 20 anaesthetists performed cricothyroidotomy with all four devices in r and om order , in a pig larynx and trachea model covered in cured pelt . The primary endpoints were the rate of successful placement of the cricothyroidotomy device into the trachea and the duration of the insertion attempt . RESULTS The Melker ® and Quicktrach 2 ® devices possessed advantages over the surgical approach , in contrast to the PCK ® device , which performed less well . All 20 participants inserted the Melker ® , with 19 being successful using the surgical approach and the Quicktrach 2 ® , whereas only 12 successfully inserted the PCK ® device ( PCK ® vs surgical , P=0.02 ) . The Quicktrach 2 ® had the fastest insertion times and caused least trauma to the posterior tracheal wall . The Melker ® was rated highest by the participants and was the only device rated higher than the surgical technique . CONCLUSIONS The Melker ® and Quicktrach 2 ® devices appear to hold particular promise as alternatives to surgical cricothyroidotomy . Further studies , in more clinical ly relevant models , are required to confirm these initial positive findings STUDY OBJECTIVE To compare the success rate , complication rate and time required for the rapid 4-step technique versus the st and ard technique for cricothyrotomy . METHODS We conducted a prospect i ve , r and omized crossover study . Twenty-seven emergency medicine interns , 1 junior medicine resident , and 4 senior medical students , without prior cricothyrotomy experience , were r and omly divided into 2 groups . Group 1 was initially instructed in and then performed the st and ard technique ; group 2 was initially instructed in and then performed the rapid 4-step technique . Each group was then instructed in and performed the alternate method .  Cricothyrotomies were performed on preserved human cadavers . RESULTS A surgical airway was established in 28 of 32 attempts with the use of the rapid 4-step technique ( 88 % ) ; the average time elapsed before tube placement was 43 seconds . Thirty of 32 attempts involving the st and ard technique ( 94 % ) were successful ; the average time to tube placement was 134 seconds ( 95 % confidence interval for a difference of 91 seconds , 63 to 119 ; P < .001 ) . Complications were identified in 12 attempts involving the st and ard technique ( 38 % ; 1 considered major ) and in 12 involving the rapid four-step technique ( 38 % ; 3 considered major ) . The incidence of major complications was 6 % higher for the rapid 4-step technique ( 95 % confidence interval , -9 % to 21 % ) . CONCLUSION In a group of inexperienced subjects working on a preserved human cadaver model , the rapid 4-step technique for cricothyrotomy was performed in about one third the time required for performance of the st and ard technique . This finding was both clinical ly and statistically significant . Although the 2 techniques had similar success and complication rates , we noted a trend toward more severe complications in the rapid 4-step technique OBJECTIVE To compare the speeds and success rates of placement for percutaneous cricothyrotomy versus surgical or open cricothyrotomy . METHODS Twenty-two paramedics ( mean 9.7 years of experience ) , with training in both methods , were timed using a pig trachea in a crossover model . An emergency physician performed timing and documentation of success ; timing commenced after the equipment was ready and the membrane was identified . Paramedics were r and omly assigned by a coin toss to start in either group . All were actively employed by a municipal third-service emergency medical services ( EMS ) agency . Paramedics who did not complete one of the methods correctly were excluded from speed analysis . Data were analyzed using descriptive statistics , a t-test of paired sample s , and confidence intervals for matched sample s. RESULTS Placement of a surgical cricothyrotomy  was significantly faster ( mean 28 seconds , range 10 - 78 seconds ) than the percutaneous method ( mean 123 seconds , range 58 - 257 seconds ) ( p < 0.001 ) . Mean difference between the 20 matched percutaneous versus surgical pairs was 93.75 seconds ( 95 % CI 72.3 , 115.2 ) . The surgical route had a 100 % success rate at obtaining airway control , whereas the percutaneous method had a 90.9 % success rate ( p = 0.1 ) . CONCLUSION In an animal model , surgical cricothyrotomy appeared to be a preferable method for establishing a definitive airway over the percutaneous method . Further research is required to define the optimal approach in the prehospital setting for the invasive airway Using an airway mannequin and artificial lung model , we compared surgical cricothyroidotomy with a 6.0‐mm cuffed Portex tracheostomy tube with wire‐guided cricothyroidotomy using a 5.0‐mm cuffed Melker or 6.0‐mm uncuffed Melker tube . The trial was carried out by 27 anaesthetists using a r and omised , crossover design . Surgical cricothyroidotomy  proved significantly faster ( mean ( SD ) time to first breath 44.3 ( 12.5 ) s for Portex surgical , 87.2 ( 21.6 ) s for cuffed Melker , 87.8 ( 19.2 ) s for uncuffed Melker , p < 0.001 ) . With a st and ardised ventilator model , the cuffed tubes provided more effective ventilation ( mean ( SD ) tidal volume 446 ( 41 ) ml Portex , 436 ( 52 ) ml cuffed Melker , 19 ( 5 ) ml uncuffed Melker , p < 0.001 ) . Fourteen of the participants preferred the wire‐guided system . We conclude that , in this model , a cuffed device is preferable when cricothyroidotomy is needed . In addition , the surgical method is quicker than a wire‐guided approach The Rapid Four-Step Technique ( RFST ) has been demonstrated to be faster than st and ard 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 r and omized , experimental trial used a fresh-frozen cadaver model of cricothyrotomy to compare speed and safety between RFST using a Bair Claw and st and ard 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 st and ard 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 st and ard 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 st and ard open technique in a fresh-frozen cadaver model of cricothyrotomy . The two techniques were equal with regard to maximal ET tube size BACKGROUND : We compared two emergency cricothyroidotomy kits design ed to avoid lesions during insertion , one based on the Seldinger technique ( ST ) , the other based on the concept of a mechanical detection of the posterior wall of the larynx , with regard to insertion time , success rate , and complication rate . METHODS : Cricothyroidotomy was performed under fiberoptic control in 40 human cadavers embalmed according to Thiel ’s technique . The set chosen for use was r and omized : new technique ( NT ) or ST . Duration of the procedure , success rates , and incidence of laryngeal injuries were compared . Traumatic lesions observed with the fiberoptic bronchoscope were anatomically confirmed after dissection . RESULTS : The two groups had comparable epidemiological and anatomical records . Cricothyroidotomy was performed faster with the NT than with the ST ( median 54 vs 71 s , P = 0.01 ) . Failure rates were comparable between groups ( 4 vs 1 , P = 0.34 ) , and there were fewer major complications in the posterior tracheal wall with the ST ( 0 vs 8 , P = 0.003 ) . In the ST group , only minor punctiform lesions of the posterior trachea wall were observed in four cases . CONCLUSIONS : In this model , despite a shorter insertion time , the NT produced more lesions and more failures than the ST We compared a wire-guided cricothyrotomy technique vs. st and ard surgical cricothyrotomy in terms of accuracy in placement , complications , performance time , incision length , and user preference . We conducted a r and omized , crossover controlled trial in which Emergency Medicine ( EM ) attendings and residents performed cricothyrotomies by both st and ard and wire-guided techniques ( using a commercially available kit ) on human cadavers after a 15-min training session .  Procedure time , incision length , and physician preference were recorded . Cadavers were inspected for accuracy of placement and complications . Airway placement was accurate in 13 of 15 cases for the st and ard technique ( 86.7 % ) , and 14 of 15 cases for the wire-guided technique ( 93.3 % ) . When comparing wire-guided vs. st and ard techniques , there were no differences in complication rates or performance times . The wire-guided technique result ed in a significantly smaller mean incision length than the st and ard technique ( 0.53 vs. 2.53 cm , respectively , p<0.0001 ) . Overall , 14 of 15 physicians stated that they preferred the wire-guided to the st and ard technique . Our data suggest that this wire-guided  cricothyrotomy  technique is as accurate and timely to use as the st and ard technique and is preferred by our physician operators . In addition , the technique results in a smaller incision on human cadaver models BACKGROUND Emergency cricothyrotomy is the final lifesaving option in " can not intubate-cannot ventilate " situations . Fast , efficient and safe management is indispensable to reestablish oxygenation , thus the quickest , most reliable and safest technique should be used . Several cricothyrotomy techniques exist , which can be grouped into two categories : anatomical-surgical and puncture . M 
    Output:
    
No single method was shown to be better than the others , but the size of the studies makes it impossible to draw firm conclusions .