Can nurses perform surgical cricothyrotomy with acceptable success and complication rates?
OBJECTIVE
This study was undertaken to determine whether flight nurses can perform surgical cricothyrotomies with acceptable success and complication rates.


METHODS
This case series examined the survival, success, and complication rates of surgical cricothyrotomy. A specially trained flight nurse retrospectively reviewed all prehospital, emergency department, inpatient, autopsy, and outpatient follow-up records.


RESULTS
Fifty-five consecutive patients in whom surgical cricothyrotomy was attempted by a flight nurse during a two-and-one-half-year period were studied. Patients ranged in age from 9 to 76 years. The airway was not cannulated successfully by a flight nurse in two patients. In two patients, the tube was not in the cricothyroid space (one in the upper tracheal rings, and the other in the larynx). In three patients, packing was insufficient to stop bleeding from around the operative site; and in three the tube became occluded by blood in the emergency department. Finally, two patients developed subglottic stenosis.


CONCLUSIONS
Surgical cricothyrotomy in the field can be performed reliably by specially trained nurses. Because only the most critically ill or injured patients with unmanageable airways are subjected to this procedure, a significant complication rate can be anticipated.
Nugent
W L
WL
Department of Nursing Administration, University of California, Davis Medical Center, Sacramento 95817.
Rhee
K J
KJ
Wisner
D H
DH
D000293:Adolescent; D000328:Adult; D000337:Aerospace Medicine; D000368:Aged; D000402:Airway Obstruction / Q000601:surgery; D002648:Child; D002983:Clinical Competence; D003413:Cricoid Cartilage / Q000601:surgery*; D004509:Education, Nursing, Continuing; D004632:Emergency Medical Services; D006801:Humans; D007442:Intubation, Intratracheal; D008875:Middle Aged; D009726:Nurses; D009732:Nursing Care / Q000592:standards; D011183:Postoperative Complications; D012151:Resuscitation / Q000193:education; D012189:Retrospective Studies; D013957:Thyroid Cartilage / Q000601:surgery*; D014187:Transportation of Patients