SURGICAL CRICOTHYROIDOTOMY IN TRAUMA PATIENTS - ANALYSIS OF ITS USE BY PARAMEDICS IN THE FIELD

Objective: To analyze the indications for and the success rate, compli cations, and neurologic outcomes of surgical cricothyroidotomy when pe rformed in the field by ambulance paramedics. Methods: The ambulance a nd hospital records of all trauma patients on whom a surgical cricothy roidotomy was attempted in the field by ambulance paramedics over a 5- year period were reviewed, A telephone survey of survivors was used to assess long-term complications and neurologic outcome. Results: Surgi cal cricothyroidotomy was attempted on 50 patients, or 9.8% of those r equiring definitive airway control. The most common indications were c lenched teeth, blood or vomit obscuring visualization of the upper air way, severe maxillofacial injuries, and inaccessibility because the pa tient was trapped, Airway establishment was successful in 47 patients (94%). Major complications occurred in 2 patients (4%), where inadvert ent dislodgement of the tube developed, requiring replacement, No pati ent developed significant subglottic stenosis, Nineteen patients (38%) survived and no patient died because of an inadequate airway, Evaluat ion of neurologic outcome revealed 12 patients (63%) with no significa nt deficits, 3 (16%) with moderate disability, 2 (10%) with severe dis ability, and only 2 in a persistent vegetative state. Conclusions: Sur gical cricothyroidotomy can be performed on the critically injured pat ient in the field by ambulance paramedics with a high success rate and a low complication rate. The use of surgical cricothyroidotomy should be included in airway protocols for well-trained, ambulance Advanced Life Support paramedics.