Emergent cricothyroidotomies for trauma: training considerations.
BACKGROUND
Emergent cricothyroidotomy remains an uncommon, but life-saving, core procedural training requirement for emergency medicine (EM) physician training. We hypothesized that although most cricothyroidotomies for trauma occur in the emergency department (ED), they are usually performed by surgeons.


METHODS
We conducted a retrospective analysis of all emergent cricothyroidotomies for trauma presentations performed at 2 large level I trauma centers over 10 years. Operators and assistants for all procedures were identified, as well as mechanism of injury and patient demographics were examined.


RESULTS
Fifty-four cricothyroidotomies were analyzed. Patients had a mean age of 50 years, 80% were male, and 90% presented as a result of blunt trauma. The most common primary operator was a surgeon (n = 47, 87%), followed by an emergency medical services (EMS) provider (n = 6, 11%) and an EM physician (n = 1, 2%). In all cases, except those performed by EMS, the operator or assistant was an attending surgeon. All EMS procedures resulted in serious complications compared with in-hospital procedures (P < .0001).


CONCLUSIONS
(1) Prehospital cricothyroidotomy results in serious complications. (2) Despite the ubiquitous presence of EM physicians in the ED, all cricothyroidotomies were performed by a surgeon, which may present opportunities for training improvement.
Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA. dking3@partners.org
David R
DR
King
Michael P
MP
Ogilvie
George
G
Velmahos
Hasan B
HB
Alam
Marc A
MA
Demoya
Susan R
SR
Wilcox
Ali Y
AY
Mejaddam
Gwendolyn M
GM
Van Der Wilden
Oscar A
OA
Birkhan
Karim
K
Fikry
D004635:Emergency Medicine; D005260:Female; D013502:General Surgery; D006801:Humans; D007830:Larynx / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010820:Physicians; D012189:Retrospective Studies; D014139:Tracheostomy / Q000193:education / Q000706:statistics & numerical data*; D014193:Trauma Centers / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000601:surgery* / Q000628:therapy