Cricothyrotomy: A 5-year experience at one institution

Aaron E Bair, Edward A Panacek, David H Wisner, Ryan Bales, John C. Sakles

Research output: Contribution to journalArticle

116 Citations (Scopus)

Abstract

We describe the prevalence, primary indications and immediate complications of emergency cricothyrotomy (cric) techniques, in a single institution's Emergency Department (ED) and associated air-medical transport service. This is a retrospective review at an academic, level-one trauma center with an annual ED census of 65,000 and an associated air-medical transport service (AMTS). All patients undergoing cric in the field or in the ED between July 1995 and June 2000 were included. Expert reviewers from Emergency Medicine, Trauma Surgery and the AMTS prospectively defined the complication criteria. All charts with a possible complication underwent a blinded evaluation by reviewers representing each of the three clinical services. Descriptive statistics were used to summarize the data. Fifty crics were performed over 5 years. Seventy-six percent of crics were performed in trauma patients. The prevalence of cric in patients requiring airway management in the ED was 1.1% (95% CI, 0.7-1.6) and 10.9% (95% CI, 6.9-16.1) in the field by the AMTS. The prevalence of complications was 14% (95% CI, 4-32.6) in ED patients and 54.5% (95% CI, 32-75.6) for prehospital patients. The overall inter-rater agreement for complication rate was excellent (kappa = .87). Overall, 77% of crics were performed using the rapid four-step technique (RFST). There were no reports of complications associated with the RFST when performed in the ED. Non-RFST crics in the ED had an associated complication rate of 25% (95% CI, 2.8-60). Emergency cricothyrotomy was performed in approximately 1% of all emergency airway cases in the ED and at a higher rate by the AMTS. The most frequent indications were trauma related. Additionally, the RFST was the most commonly used technique for cric at this institution. The complication rate of cric was significantly higher in the prehospital environment than in the ED.

Original languageEnglish (US)
Pages (from-to)151-156
Number of pages6
JournalJournal of Emergency Medicine
Volume24
Issue number2
DOIs
StatePublished - Feb 2003

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Hospital Emergency Service
Air
Emergencies
Wounds and Injuries
Airway Management
Emergency Medicine
Trauma Centers
Censuses

Keywords

  • Airway management
  • Cricothyroidotomy
  • Cricothyrotomy
  • Intubation

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Cricothyrotomy : A 5-year experience at one institution. / Bair, Aaron E; Panacek, Edward A; Wisner, David H; Bales, Ryan; Sakles, John C.

In: Journal of Emergency Medicine, Vol. 24, No. 2, 02.2003, p. 151-156.

Research output: Contribution to journalArticle

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abstract = "We describe the prevalence, primary indications and immediate complications of emergency cricothyrotomy (cric) techniques, in a single institution's Emergency Department (ED) and associated air-medical transport service. This is a retrospective review at an academic, level-one trauma center with an annual ED census of 65,000 and an associated air-medical transport service (AMTS). All patients undergoing cric in the field or in the ED between July 1995 and June 2000 were included. Expert reviewers from Emergency Medicine, Trauma Surgery and the AMTS prospectively defined the complication criteria. All charts with a possible complication underwent a blinded evaluation by reviewers representing each of the three clinical services. Descriptive statistics were used to summarize the data. Fifty crics were performed over 5 years. Seventy-six percent of crics were performed in trauma patients. The prevalence of cric in patients requiring airway management in the ED was 1.1{\%} (95{\%} CI, 0.7-1.6) and 10.9{\%} (95{\%} CI, 6.9-16.1) in the field by the AMTS. The prevalence of complications was 14{\%} (95{\%} CI, 4-32.6) in ED patients and 54.5{\%} (95{\%} CI, 32-75.6) for prehospital patients. The overall inter-rater agreement for complication rate was excellent (kappa = .87). Overall, 77{\%} of crics were performed using the rapid four-step technique (RFST). There were no reports of complications associated with the RFST when performed in the ED. Non-RFST crics in the ED had an associated complication rate of 25{\%} (95{\%} CI, 2.8-60). Emergency cricothyrotomy was performed in approximately 1{\%} of all emergency airway cases in the ED and at a higher rate by the AMTS. The most frequent indications were trauma related. Additionally, the RFST was the most commonly used technique for cric at this institution. The complication rate of cric was significantly higher in the prehospital environment than in the ED.",
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