Cricothyrotomy in the Emergency Department-A Video Review Study

Cricothyrotomy in the emergency department (ED) is a critical airway management procedure. Because cricothyrotomy is infrequently performed, there is little data on its performance in the ED.

Given the lack of high-quality real-world data, we sought to use video review to enable detailed descriptions of ED cricothyrotomy procedures.

We performed a retrospective, observational study using primarily video review. We identified patients undergoing attempts at surgical airway in a high-volume ED from 2007 to 2020 and recorded details including approach, timing, success, and complications.

We identified 25 patients who underwent cricothyrotomy out of approximately 10,000 intubations. The most common underlying conditions were cardiac arrest (11 patients, 44%), airway obstruction and trauma (9 patients, 36%). Median time from arrival to cricothyrotomy was 24 min (interquartile ranges [IQR] 7-33 min). All but one were open surgical cricothyrotomies. Most often, a scalpel, hook, and bougie technique with midline skin incision before incising the cricothyroid membrane was used. The fastest cricothyrotomy took 24 s; the longest 685 s. The most time-consuming step was between the skin incision and hook or finger placement (median 48 s, IQR 22-78 s). The primary outcome, success of the cricothyrotomy, was achieved in 22 patients (88%, 95% CI 69%-97%). The secondary outcome, death or chronic disability attributable to airway management, occurred in 3 patients (12%), 1 dying without an airway, 1 developing brain death related to inadequate swiftness of the surgical airway, and 1 developing severe disability, likely from hypoxemia during intubation efforts.

Patients undergoing ED cricothyrotomy had a high rate of complications. These findings underscore the importance of timely and proficient cricothyrotomy in emergency airway management.