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2 results

  • Prehospital Surgical Cricothyrotomy in a Ground-Based 9-1-1 EMS System: A Retrospective Review

  • Al Lulla, Robert Dickson, Michael Wells, Matthew Gilbert, Kelly Rogers Keene, Casey Patrick
  • Journal:
    Prehospital and Disaster Medicine / Volume 39 / Issue 4 / August 2024
    Published online by Cambridge University Press:
    23 April 2024, pp. 291-294
    Print publication:
    August 2024
    • Article
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  • Background:

    Airway management is a cornerstone in the prehospital care of critically ill or injured patients. Surgical cricothyrotomy offers a rapid and effective solution when oxygenation and ventilation fail using less-invasive techniques. However, the exact indications, incidence, and success of prehospital surgical cricothyrotomy are unknown, with variable rates reported in the literature. This study aimed to examine prehospital indications and success rates for surgical cricothyrotomy within a large, suburban, ground-based Emergency Medical Services (EMS) system.

    Methods:

    This is a retrospective analysis of 31 patients who underwent paramedic performed surgical cricothyrotomy from 2012 through 2022. Key demographic parameters were analyzed, including the incidence of cardiac arrest, call type (trauma versus medical), initial airway management attempts, number of endotracheal intubation (ETI) attempts before surgical airway, and average time to the establishment of a surgical airway in relation to the number of ETI attempts. Surgical cricothyrotomy success was defined as the acquisition of four-phase end-tidal capnography reading. The primary data sources were the EMS electronic medical records, and descriptive statistics were calculated.

    Results:

    A total of 31 patients were included in the final analysis. Of those who received a surgical cricothyrotomy, 42% (13/31) occurred in the trauma setting, while 58% (18/31) were medical calls. In all patients who underwent surgical cricothyrotomy, the median (IQR) time to the procedure was 17 minutes (IQR = 11-24). In trauma patients, the median time to surgical cricothyrotomy was 12 minutes (IQR = 9-19) versus 19 minutes (IQR = 14-33) in medical patients. End-tidal carbon dioxide (ETCO2) detection and placement success was confirmed in 94% (29/31) of patients. Endotracheal intubation was attempted in 55% (17/31) before subsequent surgical cricothyrotomy, with 29% (9/31) receiving more than one ETI attempt. The median time to surgical cricothyrotomy when multiple prior intubation attempts occurred was 33 minutes (IQR = 23-36) compared to 14.5 minutes (IQR = 6-19) in patients without a preceding intubation attempt.

    Conclusion:

    Prehospital surgical airway can be performed by paramedics with a high degree of success. Identification of the need for surgical cricothyrotomy should be determined as soon as possible to allow for rapid securement of the airway and to ensure adequate oxygenation and ventilation.

  • Chapter 14 - Anesthesia for transsphenoidal pituitary surgery

  • from Section 2 - Anesthesia for nasal, sinus and pituitary surgery
  • Edited by Basem Abdelmalak, John Doyle
  • Book:
    Anesthesia for Otolaryngologic Surgery
    Published online:
    05 November 2012
    Print publication:
    18 October 2012, pp 133-142

  • Summary

    Anesthesia for head and neck trauma should be approached utilizing the basic principles of advanced trauma life support (ATLS). The general principles for the anesthetic management of other trauma surgery must be applied to ENT trauma operations. The anesthesiologist must act as the primary resuscitator and principal manager of the airway. In the primary survey, the ABCDE sequence of trauma should be performed: airway, breathing, circulation, disability and neurologic status, and exposure and overall evaluation for other injuries. In children, oxygenation and ventilation are best accomplished by a needle cricothyroidotomy. A needle cricothyroidotomy may be used to temporize the patient until a more formal surgical airway is established. Airway management is best performed with knowledge of airway anatomy, an understanding of the impact of the trauma on the airway, and a thoughtful approach to the deployment of different airway devices.