The success of battlefield surgical airway insertion in severely injured military patients: a UK perspective

Kyle, Tony; Clerc, S Le; Thomas, Albert; Greaves, Ian; Whittaker, Victoria; Smith, Jessi L.

doi:10.1136/jramc-2016-000637

Cited by 14 publications

(10 citation statements)

References 15 publications

(22 reference statements)

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“…Overall, the majority of cricothyroidotomies were performed by road-based ICPs (66.7%) with the remaining performed by the aeromedical ICPs (Table 2). All cricothyroidotomy indications were categorized as either being a part of the failed intubation algorithm or performed as the primary airway management intervention (Table 3 4 , [10][11][12][13] ).…”

Section: Resultsmentioning

confidence: 99%

Needle Cricothyroidotomy by Intensive Care Paramedics

Bye

Clair

Delorenzo

et al. 2022

Prehosp. Disaster med.

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Objective: Cricothyroidotomy is an advanced airway procedure for critically ill or injured patients. In Victoria, Australia, intensive care paramedics (ICPs) perform needle cricothyroidotomy utilizing the proprietary QuickTrach II (QTII) device. Recently, an Ambulance Victoria (AV) institutional change in workflow included pre-puncture surgical incision to assist in successful placement. This review aims to explore whether a surgical pre-incision prior to the insertion of the device improved overall procedural success rates of needle cricothyroidotomy using the QTII. Methods: This was a retrospective review of all patients who received a needle cricothyroidotomy by ICPs from May 1, 2015 through September 15, 2020. Data and patient care records were sourced from the AV data warehouse. Results: A total of 27 patients underwent a needle cricothyroidotomy with the mean age of patients being 50.2 years. Most cricothyroidotomies were performed using the QuickTrach II kit (92.6%). Prior to modification of the QTII procedure, front-of-neck access (FONA) success was 50.0%; however, this improved to 82.4% after the procedures recent update. The overall success rate of all paramedic-performed needle cricothyroidotomy during the study period was 74.1% (n = 20). Conclusions: This review demonstrates that propriety devices such as the QTII device achieve a low success rate for a FONA intervention. Despite the low frequency of this procedure, ICPs with extensive training and regular maintenance can perform needle cricothyroidotomy using scalpel assistance with a reasonable success rate. But when compared to the broader literature, success rate using a more straightforward technique such as a surgical cricothyroidotomy technique is likely going to be higher.

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Section: Resultsmentioning

confidence: 99%

Needle Cricothyroidotomy by Intensive Care Paramedics

Bye

Clair

Delorenzo

et al. 2022

Prehosp. Disaster med.

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“…8 Kyle et al performed a study into the success of airway insertion over an eight-year period in Afghanistan and found that despite the relative inexperience of the operators an overall success rate of 92% was achieved. 10 SC is considered a last resort procedure in a difficult airway algorithm; however, it has been suggested that in certain situations it may be counterproductive to delay a surgical airway intervention; in such circumstances, SC may be the best 'first resort' in definitive airway management. 11 Mabry et al describe a novel approach in which awake SC is performed first and discuss three cases of 'inevitable surgical airway', which they define as, an airway which due to being altered by severe trauma or other anatomical disruption requires advanced management.…”

Section: Airwaymentioning

confidence: 99%

“…performed a study into the success of airway insertion over an eight-year period in Afghanistan and found that despite the relative inexperience of the operators an overall success rate of 92% was achieved. 10 SC is considered a last resort procedure in a difficult airway algorithm; however, it has been suggested that in certain situations it may be counterproductive to delay a surgical airway intervention; in such circumstances, SC may be the best ‘first resort’ in definitive airway management. 11 Mabry et al.…”

Section: Primary Surveymentioning

confidence: 99%

Initial CABC: Advances that have led to increased survival in military casualties

Clough

Khan

2019

Trauma

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“…Although the requirement for a CTT in the prehospital, battlefield setting is relatively rare in people, it can be an immediately life-saving intervention ( 13 – 15 ). The procedure has a high success rate ( 13 , 14 , 16 ) and has outcomes equivalent to other methods of airway management in the prehospital setting ( 15 ).…”

Section: Introductionmentioning

confidence: 99%

Prehospital Emergency Cricothyrotomy in Dogs Part 1: Experiences With Commercial Cricothyrotomy Kits

Hardjo

Palmer²,

Haworth

2021

Front. Vet. Sci.

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The surgical cricothyrotomy (CTT) has been recommended for emergency front of neck airway access (eFONA) during a cannot intubate, cannot oxygenate scenario for military working dogs (MWD) and civilian law enforcement working dogs (operational K9s). In prehospital and austere environments, combat medics and emergency medical service providers are expected to administer emergency medical care to working dogs and may only have emergency airway kits designed for humans at their disposal. The objective of this article is to provide a detailed description of the application of such devices in cadaver dogs and highlight potential alterations to manufacturer guidelines required for successful tube placement. The kits evaluated included the Portex® PCK, Melker universal cricothyrotomy kit and H&H® emergency cricothyrotomy kit. A novel technique for awake cricothyrotomy in the dog is also described, which can also be considered for in-hospital use, together with the open surgical method described for the H&H® kit. To the authors' knowledge, this is the first publication documenting and providing instruction on the application of commercial cricothyrotomy kits in dogs.

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The success of battlefield surgical airway insertion in severely injured military patients: a UK perspective

Cited by 14 publications

References 15 publications

Needle Cricothyroidotomy by Intensive Care Paramedics

Needle Cricothyroidotomy by Intensive Care Paramedics

Initial CABC: Advances that have led to increased survival in military casualties

Prehospital Emergency Cricothyrotomy in Dogs Part 1: Experiences With Commercial Cricothyrotomy Kits

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