title: Indications and results of emergency surgical airways performed by a physician-staffed helicopter emergency service.
abstract: BACKGROUND
  Airway management is essential in critically ill or injured patients. In a "can't intubate, can't oxygenate" scenario, an emergency surgical airway (ESA), similar to a cricothyroidotomy, is the final step in airway management. This procedure is infrequently performed in the prehospital or clinical setting. The incidence of ESA may differ between physician- and non-physician-staffed emergency medical services (EMS). We examined the indications and results of ESA procedures among our physician-staffed EMS compared with non-physician-staffed services.
  
  
  METHODS
  Data for all forms of airway management were obtained from our EMS providers and analyzed and compared with data from non-physician-staffed EMS found in the literature.
  
  
  RESULTS
  Among 1871 patients requiring a secured airway, the incidence of a surgical airway was 1.6% (n=30). Fourteen patients received a primary ESA. In 16 patients, a secondary ESA was required after failed endotracheal intubation. The total prehospital ESA tracheal access success rate was 96.7%.
  
  
  CONCLUSIONS
  The incidence of ESA in our patient population was low compared with those reported in the literature from non-physician-staffed EMS. Advanced intubation skills might be a contributing factor, thus reducing the number of ESAs required.
authors.affiliation: Department of Trauma Surgery, Radboud University Medical Center, Nijmegen, The Netherlands; Helicopter Emergency Medical Service, Radboud University Medical Center, Nijmegen, The Netherlands. Electronic address: Joost.Peters@radboudumc.nl.
authors.forename: Joost
authors.initials: J
authors.lastname: Peters
authors.affiliation: Department of Anesthesiology, HEMS, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Loes
authors.initials: L
authors.lastname: Bruijstens
authors.affiliation: Medical Student, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Jeroen
authors.initials: J
authors.lastname: van der Ploeg
authors.affiliation: Department of Trauma Surgery, Radboud University Medical Center, Nijmegen, The Netherlands; Helicopter Emergency Medical Service, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Edward
authors.initials: E
authors.lastname: Tan
authors.affiliation: Department of Anesthesiology, HEMS, Radboud University Medical Center, Nijmegen, The Netherlands; Helicopter Emergency Medical Service, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Nico
authors.initials: N
authors.lastname: Hoogerwerf
authors.affiliation: Department of Trauma Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Michael
authors.initials: M
authors.lastname: Edwards
mesh_terms: D000401:Aircraft; D058109:Airway Management / Q000379:methods*; D002983:Clinical Competence; D004632:Emergency Medical Services / Q000458:organization & administration / Q000592:standards; D006801:Humans; D007442:Intubation, Intratracheal; D010348:Patient Care Team / Q000706:statistics & numerical data*; D010820:Physicians / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000628:therapy*
keywords: Airway management; Cricothyroidotomy; Emergency surgery; Emergency surgical airway; Prehospital