Emergency surgical airway access - is there a best way?

The subject of emergency surgical airway technique is one of the favourite topic of emergency, critical care, anaesthetic and pre-hospital bloggers these days.  So why shouldn't Crit-IQ join in?  Here's your chance to describe what you do.

There are a number techniques described.  Its one of the most feared procedures in clinical medicine, and with good reason - the outcomes from these events are often not good.  Many of us have had, and will have, no experience with it in practice, so almost no one can claim to be proficient in any of these methods.

This topic comes up this week because of the release of a head to head comparison of a percutaneous method versus knife-to-skin in a simulated enviroment.  The results of the study suggest that a surgical method improves times to secure access and was favoured by the 30 practitioners studied.

Of all the methods described, the one that sits most comfortably with me is the knife-dilators-bougie method.  This appears to have the support of the literature, and in my hands in a similated environment, it feels easiest.  The equipment required is readily available and familiar, so when the heat is on, is more likely to be familiar.

So what do you do?