Surgical cricothyroidotomy in trauma patients.
BACKGROUND
Surgical airway intervention is occasionally necessary due to contraindicated or failed endotracheal intubation. In cricothyroidotomy patients, a choice exists between continued long-term ventilation via the cricothyroidotomy portal or conversion to tracheostomy. We examined whether conversion to tracheostomy reduces the risk of acute complications.


METHODS
We retrospectively identified 46 patients with cricothyroidotomies performed at our level I trauma center over a 63-month period. We reviewed the success rate, indications, etiology, and complications.


RESULTS
An airway was obtained in all cases. The most common indicator for surgical airway intervention was unsuccessful endotracheal intubation. The cause of death among nonsurvivors was not due to airway complications. Of the 15 surviving patients, 8 had conversions to tracheostomy and 7 patients did not have conversions but had decannulations. The converted group had a greater percentage of acute complications than the nonconverted group.


CONCLUSIONS
Rate of acute complications with prolonged ventilation via cricothyroidotomy portal is equal to, if not lower than, via converted tracheostomy. Cricothyroidotomy in trauma patients may be used long term without any increase in acute complications.
Wright
Mary Jo
MJ
Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA.
Greenberg
David E
DE
Hunt
John P
JP
Madan
Atul K
AK
McSwain
Norman E
NE
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000075202:Contraindications; D003413:Cricoid Cartilage / Q000601:surgery*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D015601:Injury Severity Score; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D012121:Respiration, Artificial / Q000009:adverse effects*; D012189:Retrospective Studies; D013961:Thyroid Gland / Q000601:surgery*; D013997:Time Factors; D014139:Tracheostomy / Q000009:adverse effects*; D014947:Wounds and Injuries / Q000628:therapy*