A standing-order protocol for cricothyrotomy in prehospital emergency patients

To study utilization, indications, and outcomes associated with the use of a statewide, emergency medical services (EMS) standing-order protocol for cricothyrotomy.

A statewide EMS database was queried for patients who received cricothyrotomy under a standardized, standing-order protocol. Patient EMS and hospital records were reviewed in a defined sequence with information recorded on a standardized collection form.

EMS records included eight years of practice with 1.5 million patient encounters. For each year studied, approximately 540 emergency medical technicians (EMTs) were certified to perform cricothyrotomy. State EMS providers performed a collective mean of eight cricothyrotomy procedures per year (range, 1-17), for a total of 68 cricothyrotomies performed within the eight-year period. Hospital records were available for review in 61 patients. Fifty-six patients received cricothyrotomy by open surgical incision, six by needle with jet ventilation, and one by both methods. Categorization of cricothyrotomy patients as trauma or medical was 61% trauma and 39% medical. Thirty-six patients (59%) were in cardiac arrest on EMS arrival and 12 patients (20%) died during transport. Thirteen trauma patients (21%) were admitted with eight patients surviving to discharge (13%). The neurologic impairment at time of hospital discharge was severe in four, moderate in two, and minimal or none in two patients (3%).

A considerable percentage of cricothyrotomy procedures were performed on patients with non-trauma-related diagnoses in this investigation describing a standing-order EMS protocol for cricothyrotomy. The majority of patients undergoing cricothyrotomy with this protocol were in cardiac arrest at the time of cricothyrotomy, with a small minority of patients surviving to hospital discharge and fewer surviving neurologically intact.