From the Guidelines
The frequency of prehospital cricothyrotomy is extremely low, occurring in approximately 0.06 to 4.36 per 1000 patients, as reported in the most recent and highest quality study 1. This life-saving procedure, which creates an emergency surgical airway through the cricothyroid membrane, is typically reserved as a last resort when other airway management techniques have failed in cases of complete upper airway obstruction or inability to ventilate through conventional means. The rarity of prehospital cricothyrotomy reflects both the effectiveness of alternative airway management techniques and the challenging nature of performing this invasive procedure in field conditions. Some key points to consider about prehospital cricothyrotomy include:
- Success rates are typically high, with most studies reporting success rates of >70% 1
- Outcomes can vary markedly, and the procedure requires specific equipment and trained personnel
- Complications can include bleeding, incorrect placement, subcutaneous emphysema, and damage to surrounding structures
- The procedure is often performed in trauma-specific or mixed trauma and medical emergency settings, and the incidence of front-of-neck airway access attempts can vary significantly across different studies and settings 1.
From the Research
Frequency of Prehospital Cricothyrotomy
The frequency of prehospital cricothyrotomy is a rare occurrence, with various studies reporting different incidence rates.
- A study published in 2019 analyzed 19,382 dispatches and found 18 cases of prehospital cricothyrotomy, indicating a low frequency of this procedure 2.
- Another study published in 2023 estimated the prevalence of cannot ventilate-cannot oxygenate (CVCO) situations in a prehospital setting to be around 1% 3.
- A prospective, multicenter, observational study published in 2014 found that cricothyrotomy was performed in 1.8% of patients (34 out of 1,927) in a combat setting 4.
- A systematic review published in 2016 found that the incidence of short-term complications ranged from zero to 31.6%, and long-term complications ranged from zero to 7.86% 5.
- A descriptive analysis published in 2015 compared the incidence of cricothyrotomies in the deployed setting to the emergency department at a level 1 military trauma center, finding a per admission incidence of 0.24% in the deployed setting and 0.15% in the ED setting 6.
Indications and Success Rates
The indications for prehospital cricothyrotomy are diverse and include trauma and medical cases.
- The study published in 2019 found that indications for cricothyrotomy were divided into 9 trauma cases and 9 medical cases 2.
- The study published in 2014 found that mechanisms of injury were blast (79%), penetrating (18%), and blunt force (3%), and 83% had major head, face, or neck injuries 4.
- The success rate of prehospital cricothyrotomy is generally high, with the study published in 2019 reporting a success rate of 94% (17 out of 18 cases) 2.
- The study published in 2014 found that cricothyrotomy was successful in 82% of cases 4.