EFFICACY OF PREHOSPITAL SURGICAL CRICOTHYROTOMY IN TRAUMA PATIENTS

Objective: The use of surgical cricothyrotomy (SC) in the prehospital setting is controversial, and the need to teach this procedure to para medics and intermediate emergency medical technicians remains unclear, The purpose of this study is to define the efficacy, complication rat e, and overall survival after SC performed in the prehospital setting, Methods: In our region, emergency medical technicians receive trainin g in this technique using an animal model with biannual updates requir ed, We retrospectively reviewed data in our regional trauma register ( 15,686 injured patients) for the years 1991-1995, Results: Prehospital emergency airway intubation was required in 376 patients, 56 of whom received SC, The primary indications for SC were facial fractures and deformities (32%) and blood in the airway (30%), In 79% of the patient s requiring SC, attempted orotracheal intubation prior to SC was unsuc cessful, with a mean of 1.9 attempts per patient, SC was judged to pro vide an adequate airway in the field in 89% of attempts. Complications at the scene included six failed attempts, one case of excessive blee ding, and one adverse patient reaction (agitation), When patients arri ved at the trauma center, the SC was judged to be acceptable in 64%, w hereas 16% were functioning with some question of adequacy and require d airway manipulation (most commonly a mainstem bronchial intubation), Overall survival to hospital discharge was 27%; however, survival to emergency department discharge (an indicator of emergency airway adequ acy) was 62%, Using TRISS methodology, there were five unexpected surv ivors and six unexpected deaths, Only three patients were discharged w ith a ''good neurologic recovery,'' Conclusion: (1) Prehospital SC can be performed effectively with few complications after training on ani mal models (2) Goad neurologic outcome is rare after the use of this p rocedure, (3) Although it is effective, clear indications must be deve loped and followed for the prehospital use of SC.