title: Fifty-four emergent cricothyroidotomies: are surgeons reluctant teachers?
abstract: 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 occur in the emergency department (ED), they are rarely performed by EM physicians.
  
  
  METHODS
  We conducted a retrospective analysis of all emergent cricothyroidotomies performed at two large level one 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 performed. Patients were: mean age of 50, 80% male and 90% 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 a 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 to in-hospital procedures (p < 0.0001).
  
  
  CONCLUSIONS
  1. Pre-hospital cricothyroidotomy results in serious complications. 2. Despite the ubiquitous presence of emergency medicine physicians in the ED, all crico-thyroidotomies were performed by a surgeon, which may represent a serious emergency medicine training deficiency.
authors.affiliation: Massachusetts General Hospital and Harvard Medical School, Division of Trauma, Emergency Surgery, and Surgical Critical Care, Boston, MA, USA. dking3@partners.org
authors.forename: D
authors.initials: D
authors.lastname: King
authors.forename: M
authors.initials: M
authors.lastname: Ogilvie
authors.forename: M
authors.initials: M
authors.lastname: Michailidou
authors.forename: G
authors.initials: G
authors.lastname: Velmahos
authors.forename: H
authors.initials: H
authors.lastname: Alam
authors.forename: M
authors.initials: M
authors.lastname: deMoya
authors.forename: K
authors.initials: K
authors.lastname: Fikry
mesh_terms: D000328:Adult; D000368:Aged; D002983:Clinical Competence; D004632:Emergency Medical Services; D004635:Emergency Medicine / Q000193:education*; D005260:Female; D006801:Humans; D007821:Laryngeal Muscles / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010819:Physician's Role; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D014139:Tracheostomy; D014194:Traumatology / Q000193:education / Q000458:organization & administration