Emergency cricothyroidotomy

The effectiveness and safety of cricothyroidotomy was reviewed at our institution and in the literature. The literature review yielded nine reports on emergent cricothyroidotomy. Out of 320 patients, there were 308 successful airways and 99 survivors. In 172 cases (eight reports), the patient was not in cardiac arrest, and this group accounted for 84 of 99 survivors. Acute complications were rare and included bleeding and misplacement of the airway. Long-term complications were difficult to evaluate because of the small number of survivors, many of whom were in a permanent vegetative state. At our institution, we had 65 patients who underwent emergent cricothyroidotomy with 62 successful airways and 27 survivors. In 33 patients, vital signs were present at the time of emergent cricothyroidotomy. This group accounted for 25 of 27 survivors. Acute complications were: misplacement or failure to obtain an airway (seven), no airway (three), chest tube required (two), and bleeding (one). In the 27 survivors long-term complications were: failure to decannulate (two), and vocal cord paralysis, granulation tissue and hoarseness, one case each. We conclude that emergent cricothyroidotomy is effective in establishing airways in emergency situations, although the survival rate is better if the patient is not in cardiac arrest (49 vs 31% in literature and 41 vs 76% in our study).