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Published on: March 15, 2024
Traumatic airway management in Operation Iraqi Freedom
Joseph Brennan1, Mark D Gibbons, Manuel Lopez
1Wilford Hall Medical Center, Lackland Air Force Base, Texas 78236-9908, USA. Joseph.brennan@lackland.af.mil
Summary
Head and neck surgeons played a vital role in managing traumatic airways during Operation Iraqi Freedom. A new triage system classifying airways as red, yellow, or green can guide surgical management.
Area of Science:
- Trauma Surgery
- Otolaryngology
- Emergency Medicine
Background:
- Head and neck surgeons are essential for managing complex traumatic airways.
- Operation Iraqi Freedom presented unique challenges in battlefield airway management.
Purpose of the Study:
- To evaluate the role of head and neck surgeons in traumatic airway management during Operation Iraqi Freedom.
- To develop a simple airway triage classification for guiding surgical airway management.
Main Methods:
- Retrospective chart review of a case series.
- Analysis of traumatic airway cases managed by 6 otolaryngologists/head and neck surgeons over 30 months.
- Setting: Air Force Theater Hospital, Balad Air Base, Iraq.
Main Results:
- 196 patients required airway intervention.
- Penetrating face (46%) and neck (31%) trauma were the most common causes.
- 183 tracheotomies, 3 cricothyroidotomies, and 9 complicated intubations were performed.
- 68% of airways were classified as emergent or delayed (red/yellow).
- 25 patients underwent surgical repair of the laryngotracheal complex.
Conclusions:
- Deployed otolaryngologists were crucial for managing traumatic airways.
- The proposed red/yellow/green airway classification system can optimize future management.
- This classification stratifies urgency: red (<5 min), yellow (<12 hours), green (>12 hours).
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