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Prehospital Surgical Cricothyrotomy in a Ground-Based 9-1-1 EMS System: A Retrospective Review

Published online by Cambridge University Press:  23 April 2024

Al Lulla ,
Robert Dickson ,
Michael Wells Open the ORCID record for Michael Wells [Opens in a new window] ,
Matthew Gilbert ,
Kelly Rogers Keene  and
Casey Patrick Open the ORCID record for Casey Patrick [Opens in a new window]
Al Lulla
Affiliation:
Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, Texas USA
Robert Dickson
Affiliation:
Montgomery County Hospital District EMS, Conroe, Texas USA Baylor College of Medicine, Department of Emergency Medicine, Houston, Texas USA Department of Emergency Medicine, HCA Houston Healthcare-Kingwood, Kingwood, Texas USA
Michael Wells
Affiliation:
Montgomery County Hospital District EMS, Conroe, Texas USA
Matthew Gilbert
Affiliation:
Department of Emergency Medicine, HCA Houston Healthcare-Kingwood, Kingwood, Texas USA
Kelly Rogers Keene
Affiliation:
Baylor College of Medicine, Department of Emergency Medicine, Houston, Texas USA
Casey Patrick*
Affiliation:
Montgomery County Hospital District EMS, Conroe, Texas USA Baylor College of Medicine, Department of Emergency Medicine, Houston, Texas USA Department of Emergency Medicine, HCA Houston Healthcare-Kingwood, Kingwood, Texas USA
*
Correspondence: Casey Patrick, MD, FAEMS Montgomery County Hospital District EMS 1400 South Loop 336 West Conroe Texas 77304 USA E-mail: cpatrick@mchd-tx.org
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Abstract

Background:

Airway management is a cornerstone in the prehospital care of critically ill or injured patients. Surgical cricothyrotomy offers a rapid and effective solution when oxygenation and ventilation fail using less-invasive techniques. However, the exact indications, incidence, and success of prehospital surgical cricothyrotomy are unknown, with variable rates reported in the literature. This study aimed to examine prehospital indications and success rates for surgical cricothyrotomy within a large, suburban, ground-based Emergency Medical Services (EMS) system.

Methods:

This is a retrospective analysis of 31 patients who underwent paramedic performed surgical cricothyrotomy from 2012 through 2022. Key demographic parameters were analyzed, including the incidence of cardiac arrest, call type (trauma versus medical), initial airway management attempts, number of endotracheal intubation (ETI) attempts before surgical airway, and average time to the establishment of a surgical airway in relation to the number of ETI attempts. Surgical cricothyrotomy success was defined as the acquisition of four-phase end-tidal capnography reading. The primary data sources were the EMS electronic medical records, and descriptive statistics were calculated.

Results:

A total of 31 patients were included in the final analysis. Of those who received a surgical cricothyrotomy, 42% (13/31) occurred in the trauma setting, while 58% (18/31) were medical calls. In all patients who underwent surgical cricothyrotomy, the median (IQR) time to the procedure was 17 minutes (IQR = 11-24). In trauma patients, the median time to surgical cricothyrotomy was 12 minutes (IQR = 9-19) versus 19 minutes (IQR = 14-33) in medical patients. End-tidal carbon dioxide (ETCO2) detection and placement success was confirmed in 94% (29/31) of patients. Endotracheal intubation was attempted in 55% (17/31) before subsequent surgical cricothyrotomy, with 29% (9/31) receiving more than one ETI attempt. The median time to surgical cricothyrotomy when multiple prior intubation attempts occurred was 33 minutes (IQR = 23-36) compared to 14.5 minutes (IQR = 6-19) in patients without a preceding intubation attempt.

Conclusion:

Prehospital surgical airway can be performed by paramedics with a high degree of success. Identification of the need for surgical cricothyrotomy should be determined as soon as possible to allow for rapid securement of the airway and to ensure adequate oxygenation and ventilation.

Keywords

cricothyrotomyEmergency Medical Servicesprehospitalsurgical airwaytrauma
Type
Original Research
Information
Prehospital and Disaster Medicine , First View , pp. 1 - 4
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Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of World Association for Disaster and Emergency Medicine

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