Surgical cricothyroidotomy in trauma patients: analysis of its use by paramedics in the field

To analyze the indications for and the success rate, complications, and neurologic outcomes of surgical cricothyroidotomy when performed in the field by ambulance paramedics.

The ambulance and hospital records of all trauma patients on whom a surgical cricothyroidotomy was attempted in the field by ambulance paramedics over a 5-year period were reviewed. A telephone survey of survivors was used to assess long-term complications and neurologic outcome.

Surgical cricothyroidotomy was attempted on 50 patients, or 9.8% of those requiring definitive airway control. The most common indications were clenched teeth, blood or vomit obscuring visualization of the upper airway, severe maxillofacial injuries, and inaccessibility because the patient was trapped. Airway establishment was successful in 47 patients (94%). Major complications occurred in 2 patients (4%), where inadvertent dislodgement of the tube developed, requiring replacement. No patient developed significant subglottic stenosis. Nineteen patients (38%) survived and no patient died because of an inadequate airway. Evaluation of neurologic outcome revealed 12 patients (63%) with no significant deficits, 3 (16%) with moderate disability, 2 (10%) with severe disability, and only 2 in a persistent vegetative state.

Surgical cricothyroidotomy can be performed on the critically injured patient in the field by ambulance paramedics with a high success rate and a low complication rate. The use of surgical cricothyroidotomy should be included in airway protocols for well-trained, ambulance Advanced Life Support paramedics.