The success of battlefield surgical airway insertion in severely injured military patients: a UK perspective.
BACKGROUND
The insertion of a surgical airway in the presence of severe airway compromise is an uncommon occurrence in everyday civilian practice. In conflict, the requirement for insertion of a surgical airway is more common. Recent military operations in Afghanistan resulted in large numbers of severely injured patients, and a significant proportion required definitive airway management through the insertion of a surgical airway.


OBJECTIVE
To examine the procedural success and survival rate to discharge from a military hospital over an 8-year period.


METHODS
A retrospective database and chart review was conducted, using the UK Joint Theatre Trauma Registry and the Central Health Records Library. Patients who underwent surgical airway insertion by UK medical personnel from 2006 to 2014 were included. Procedural success, demographics, Injury Severity Score, practitioner experience and patient survival data were collected. Descriptive statistics were used for data comparison, and statistical significance was defined as p<0.05.


RESULTS
86 patients met the inclusion criterion and were included in the final analysis. The mean patient age was 25 years, (SD 5), with a median ISS of 62.5 (IQR 42). 79 (92%) of all surgical airways were successfully inserted. 7 (8%) were either inserted incorrectly or failed to perform adequately. 80 (93%) of these procedures were performed either by combat medical technicians or General Duties Medical Officers (GDMOs) at the point of wounding or Role 1. 6 (7%) were performed by the Medical Emergency Response Team. 21 (24%) patients survived to hospital discharge.


CONCLUSIONS
Surgical airways can be successfully performed in the most hostile of environments with high success rates by combat medical technicians and GDMOs. These results compare favourably with US military data published from the same conflict.
Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research & Academia), Medical Directorate, Birmingham, UK.|Academic Department of Military Emergency Medicine (North), Institute of Learning Research & Innovation, James Cook University Hospital, Middlesbrough, UK.
Tony
T
Kyle
Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research & Academia), Medical Directorate, Birmingham, UK.|Emergency Department, James Cook University Hospital, Middlesbrough, UK.
S
S
le Clerc
Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research & Academia), Medical Directorate, Birmingham, UK.
A
A
Thomas
Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research & Academia), Medical Directorate, Birmingham, UK.|Emergency Department, James Cook University Hospital, Middlesbrough, UK.
I
I
Greaves
Health and Social Care Institute, Teesside University, Middlesbrough, UK.
V
V
Whittaker
Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research & Academia), Medical Directorate, Birmingham, UK.|Emergency Department, Derriford Hospital, Plymouth, UK.
J E
JE
Smith
D000328:Adult; D055826:Afghan Campaign 2001-; D058109:Airway Management / Q000379:methods*; D016208:Databases, Factual; D004632:Emergency Medical Services / Q000379:methods*; D004634:Emergency Medical Technicians; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007821:Laryngeal Muscles / Q000601:surgery*; D008297:Male; D008887:Military Medicine; D008889:Military Personnel; D012042:Registries; D012189:Retrospective Studies; D006113:United Kingdom; D014947:Wounds and Injuries / Q000628:therapy*; D055815:Young Adult
airway obstruction; cricothyroidotomy; military; multiple trauma; surgical airway