Abstract / Summary
Emergency cricothyroidotomy is the definitive rescue technique in “cannot intubate, cannot oxygenate” (CICO) situations. Although international guidelines recommend the surgical technique over the percutaneous approach, the relative retention of these skills after training remains unclear. This study aimed to compare six-month retention of surgical and percutaneous cricothyroidotomy skills among critical care residents after simulation-based training. This prospective, randomized, crossover study involved first-year anesthesiology and emergency medical residents. The study was conducted in two sessions separated by a six-month interval. During Session 1, participants received theoretical instruction followed by practical training and a baseline performance assessment on low-fidelity models. Six months later, retention was evaluated (Session 2) using a high-fidelity CICO simulation under realistic conditions. The primary outcome was the retention index, defined as the proportional change in performance time between Sessions 1 and 2. Secondary outcomes included performance time, successful cricothyroidotomy, retention of procedural steps, self-confidence, and perceived stress. These outcomes were assessed using standardized checklists, self-administered questionnaires on confidence and stress levels, and continuous heart rate monitoring by ECG Holter during procedural performance. Thirty-one residents (79%) completed both sessions, with 29 (94%) successfully performing at least one technique. The retention index showed no significant difference between surgical and percutaneous cricothyroidotomy (0.93 vs. 1.03; p = 0.92). Performance time increased significantly for both techniques after six months ( p < 0.001), though the surgical approach remained faster (68 ± 46.0 s vs. 113 ± 79.3 s; p < 0.001). Procedural step retention ( p = 0.037) and self-confidence ( p = 0.008) were significantly higher for the surgical technique. Heart rate increased significantly during simulation ( p < 0.001), confirming stress induction, but did not differ between techniques. Retention of surgical and percutaneous cricothyroidotomy skills at six months was not different, but both showed marked performance decay, emphasizing the need for more frequent retraining. The secondary outcomes showed superior speed, confidence, and procedural understanding with the surgical approach, which may support its preferential use and prioritization in simulation-based airway training programs.