To the Editor:
We found the article by Drs Platts-Mills et al to be of particular interest. 1 They evaluated an improvisational method of cricothyrotomy with commonly available materials, in this case a high-flow intravenous spike and drip chamber, in an austere setting. However, we wish to correct 2 central premises of their paper.
They state that “considerable attention has focused on improvisational approaches that could be used in a wilderness or prehospital setting … but there are no reports of their use in the literature.” 1 Actually, we previously described a roadside cricothyrotomy where one of us used a sports bottle straw and a pocketknife to obtain a surgical airway on a trauma victim. 2 Dr Platts-Mills’ reminder to occlude the victim's mouth is well heeded, especially when performing mouth-to-tube ventilations. This improvisational technique with a sports bottle straw is also described in the Basic Disaster Life Support Course® manual. 3 Furthermore, they state once in their abstract, twice in the introduction, and again in their conclusion that “no improvised airway devices of this type have been tested in a systematic manner.” We wish to respectfully direct the authors to our recent work in this field. 2 Using a body plethysmograph on normal volunteers, we compared the airway resistances (Raw) of 2 types of sports bottle straws and the barrel from a ballpoint pen to standard cricothyrotomy airways (a 7.0 endotracheal tube and a 8.0 Shiley tracheostomy tube). The sports bottle straws were as effective as the standard airway devices, and we found no statistically significant difference in their Raw. However, the pen barrel (even with its tip cut off to maximize its cross sectional area) had a much higher Raw and is an unacceptable choice.
We commend the authors for validating this procedure because a rapid improvised airway can be a lifesaving bridge until advanced airway management can be implemented. Interestingly, there are now several anecdotal reports of improvised cricothyrotomy on the battlefields of Operation Iraqi Freedom using this technique which was pioneered by Fisher.4,5
The views expressed in this article are those of the authors and do not reflect the official policy of the Department of the Army, the Department of Defense, or the US Government.