Discussion
SECONDARY, COMPLICATIONS
This study demonstrated equivalent accuracy and time required for successful CTM identification between the top-down manoeuvre and the bottom-up manoeuvre, performed by fifth-year medical students instructed newly on these methods and without any prior experience performing cricothyrotomy.Both the accuracy and the time taken to identify the CTM are similar to those reported in other studies. The accuracy of CTM identification by palpation methods has been estimated to range from 30–72% [These findings suggest that the bottom-up manoeuvre may be effectively used as an alternative to the top-down manoeuvre, expanding the available range of options for CTM identification and improving the safety of cricothyrotomy. Given that the difficulty associated with CTM identification is the primary cause of cricothyrotomy failure and complications [In contrast to our findings, Chang et al. [This study had some limitations. First, we could not have fully concealed the study protocol, as we did not prohibit other team members from observing the technique of an examinee when they measured the time required for CTM identification. Second, the study results may not be generalisable to clinical populations because the CTM identification was performed on a single person. The person in the role of a patient in this study was a male, who had a high BMI, and his thyroid cartilage was undetectable without deep palpation. He was also able to extend his neck fully. Further research is required to validate the present findings in individuals with other types of body habitus. Third, this study may have omitted the problem of multiple testing because it evaluated two important outcomes, including accuracy and time required. However, since we prioritised the primary and secondary outcomes and reported the results of all the tests performed in this study, we consider that the multiple testing problem was avoided to a certain extent [