Airway management for patients with penetrating neck trauma: a retrospective study

Airway management in patients with penetrating neck trauma is controversial. We reviewed the records of 107 patients with penetrating neck trauma from 1989 through 1991 for primary intubation technique, mechanism of injury, zone of injury, and structures injured. Six patients (6%) received a surgical airway as the primary choice, 89 (83%) had direct laryngoscopies after rapid sequence induction of anesthesia, eight (7%) had awake fiberoptic bronchoscopies, and four (4%) had awake blind nasotracheal intubation. The success rates for primary surgical were 100%, fiberoptic 100%, direct laryngoscopy 98%, and blind nasal 75%. Two (2%) of the patients in the direct laryngoscopy group required a secondary emergency surgical airway. One failed blind nasal attempt (25%) resulted in the patient's death due to loss of airway during a secondary attempt at an emergency surgical airway. A second patient died as a result of hemorrhage not related to airway management. Success rates were not statistically different with any of the four airway management techniques chosen primarily. However, the one death in the awake nasal intubation group and the technical and time constraints of fiberoptic intubation cause us to prefer rapid sequence induction of anesthesia with direct laryngoscopy or a primary surgical airway in patients with penetrating neck trauma who need an emergency airway.