Surgical cricothyrotomy in the wilderness: a case report

Although the surgical cricothyrotomy procedure is used on combat casualties in the most challenging environments, we are unaware of any published report in the United States of surgical cricothyrotomy performed in a wilderness recreational setting. We describe a 31-year-old male rock climber who fell 24.4 m (80 feet), sustaining serious injuries and requiring rescue from the base of the cliff by a cave/cliff rescue team. Ultimately, a surgical cricothyrotomy proved necessary because of ongoing oropharyngeal bleeding, facial fractures creating an unstable airway, and the need to place the patient in the litter. The patient survived a prolonged and arduous evacuation. This report presents the management of the patient during the rescue and the challenges faced by the rescue team physician and others that led to the decision to perform an improvised surgical cricothyrotomy.