Optimizing Emergent Surgical Cricothyrotomy for use in Austere Environments

Abstract

Emergent cricothyrotomy is an infrequently performed procedure used in the direst of circumstances on the most severely injured patients. Austere environments present further unique challenges to effective emergency medical practice. Recently, military trauma registry data were searched for the frequency of cricothyrotomy use and success rates during a 22-month period. These data revealed that cricothyrotomy performed in the most rigorous austere environment (ie, battlefield) had many successes, but also a large number of failed (33%) attempts by medics owing to many factors. Thus, the aim of this review article is to present what is known about cricothyrotomy and apply this knowledge to any austere environment for qualified providers. The National Library of Medicine's PubMed was used to conduct a thorough search using the terms "prehospital," "cricothyroidotomy," "cricothyrotomy," and "surgical airway." The findings were further narrowed by applicability to the austere environment. This review presents relevant airway anatomy, incidences, indications, contraindications, procedures, and equipment, including improvised devices, success rates, complications, and training methods. Recommendations are proffered for ways to optimize procedures, equipment, and training for successful application of this emergent skill set in the austere environment.

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

“…Discussion with multinational senior clinicians based at both the Role 3 and Role 1 echelons identified the perception of a lack of standardised approach and equipment as potential reasons for the complications associated with their findings 5. A review article in 2013 identified 12 distinct surgical cricothyroidotomy procedures and numerous variations of cricothyroidotomy equipment seemed to reinforce this concept 17. Common themes have appeared where training, simulation and practice are described as imperative for success 7 8 15 16 18.…”

The emergency surgical airway

“…At least 10 different surgical techniques have been described. 9 It is the opinion of the authors that the techniques described above offer several advantages: What equipment is required?…”

“…9 It is the opinion of the authors that the techniques described above offer several advantages: What equipment is required? 9 It is the opinion of the authors that the techniques described above offer several advantages: What equipment is required?…”

Wilderness medicine

“…These advances are now crossing over to civilian EMS systems, tactical units, and wilderness medicine. [91][92][93][94][95][96][97][98] …”