Emergency Cricothyroidotomy in Trauma Victims

Complications of Intubation and Emergency Airway Management

“…Complications occur in 13% to 40% of cases of emergency cricothyroidotomy. [59][60][61][62][63] The complication rate of emergency tracheotomy is estimated to be three times greater than the 15% complication rate observed for elective tracheotomy. 64 In addition, higher complication rates are observed for emergency surgical airways performed in the inpatient setting as compared with the emergency room, perhaps as a result of the younger, predominantly male trauma population that requires surgical airway establishment in the emergency room suite.…”

“…66,67 Consideration should be given to converting a cricothyroidotomy to a tracheotomy if the patient requires the tube for more than 1 week. 57 Subglottic stenosis after emergency cricothyroidotomy was observed in 5% (1 of 21) to 13% (2 of 15) of survivors in two case series that assessed for this complication 57,60 ; therefore the overall risk of this complication is thought to be acceptable given the clinical indications. …”

Alternate Airways in the Prehospital Setting (Resource Document to NAEMSP Position Statement)

“…38 Although described as a safe and rapid procedure, the technique requires adequate training for proper execution. [39][40][41][42] Cricothyroidotomy has been studied in the hospital and emergency department settings as both a primary and alternate airway. 43,44 Because of the plasticity of the pediatric airway, it is contraindicated in children less than 8 years old.…”

“…42,45 Although widely taught, the prehospital application of cricothyroidotomy appears to be rare and associated with significant complications and poor outcomes. 37,42,46,47 …”

The Traumatic Airway: The Anesthesiologist's Role in the Emergency Room

“…Emergency cricothyroidotomy-in experienced hands-is a relatively safe and quick means of obtaining an airway when endotracheal intubation fails or is contraindicated. 6 Approximately 5% of trauma victims will require an emergency cricothyroidotomy to establish an airway. A second person will need to be assigned to assist the anesthesiologist, preferably one trained to give cricoid pressure.…”